Genetic construct

ABSTRACT

The invention provides genetic constructs and recombinant vectors comprising such constructs. The constructs and vectors can be used in gene therapy methods for treating a range of disorders, including glaucoma and deafness, or for promoting nerve regeneration and/or survival.

The present invention relates to genetic constructs and recombinantvectors comprising such constructs, and to the uses of the constructsand vectors in gene therapy methods for treating a range of disorders,including glaucoma and deafness, or for promoting nerve regenerationand/or survival.

Glaucoma is a term used to define a group of ocular disorderscharacterised by progressive optic nerve degeneration, death of retinalganglion cells (RGC) and axon loss, which results in an excavatedappearance of the optic nerve head and loss of vision. Glaucoma is aleading cause of blindness worldwide [1] and the incidence of glaucomaincreases dramatically with age. Around half a million people in theU.K. and more than 2.2 million people in North America aged 40 and olderhave glaucoma. Moreover, every hour, someone goes blind from thissight-threatening disease in the U.S. [2]. As the size of the elderlypopulation continues to grow rapidly, glaucoma has become an imminentsocial as well as medical problem. Elevated intraocular pressure (IOP)is the most important risk factor for glaucoma [3], besides age and allcurrently licensed treatments work by lowering IOP [4-5].

Glaucoma can be diagnosed prior to loss of vision by visual fieldtesting and by ophthalmoscopic examination of the optic nerve to detect“cupping”. Current management of glaucoma is based on lowering the IOPto normal levels, which are between to and 21 mm Hg, in order to preventfurther optic nerve damage using topically applied drugs [6]. The meanIOP in normal adults is 15 to 16 mm Hg. Currently there are five majorclasses of medications that are used to lower the IOP: β-adrenergicantagonists, adrenergic agonists, parasympathomimetics,prostaglandin-like analogues and carbonic anhydrase inhibitors [7].Whilst relatively effective in reducing IOP when correctly used, thesedrugs can cause severe side effects in some patients and therebyadversely affect the quality of the patient's life. In addition,adherence to IOP-lowering eye drop treatment is often poor, particularlyin elderly patients who are required to take multiple medications. Ithas been estimated that less than 50% of patients prescribed IOPlowering treatment actually use it regularly as directed, with obviousimplications for control of the underlying condition. If additionallowering of IOP is indicated, or if medication fails to sufficientlylower the IOP, laser trabeculoplasty may be used, but this treatmentfails to achieve adequate IOP lowering in many patients. If IOP is stillnot adequately controlled, incisional glaucoma surgery may be indicated.However, IOP lowering treatment fails to prevent deterioration in manypatients and glaucoma remains the leading cause of irreversibleblindness worldwide. Neuroprotection of the glaucomatous RGCs and theiraxon projections, which form the optic nerve, would therefore be avaluable therapeutic paradigm for use as an adjunct to conventional IOPlowering treatments and particularly important in patients deterioratingdespite conventional therapy [8].

Glaucomatous optic neuropathy appears to result from specificpathophysiological changes and subsequent death of RGCs and their axons.The process of RGC death is thought to be biphasic, i.e. a primaryinjury responsible for initiation of damage followed by a slower,secondary degeneration attributable to the hostile environmentsurrounding the degenerating cells [9].

RGC death mechanisms in experimental animal models of glaucoma and humanglaucoma have been shown to involve apoptosis [10]. Although themolecular mechanism triggering apoptosis has not been identified,deprivation of neurotrophic factors, ischemia, chronic elevation ofglutamate and disorganized nitric oxide metabolism are suspected to bepossible mechanisms [11].

Brain-derived neurotrophic factor (BDNF) along with nerve growth factor(NGF), neurotrophin-3 (NT-3), and neurotrophin-4/5 (NT-4/5) are membersof the neurotrophin family of trophic factors [12-13]. The neurotrophinsplay essential roles in the development, survival and function of a widerange of neurons in both the peripheral and central nervous systems,including RGCs. Neurotrophins interact with two cell surface receptors,low affinity p75^(NTR) receptors and the high affinity tyrosine receptorkinase (Trk) family [12-13]. Nerve growth factor (NGF) preferentiallybinds TrkA, Brain Derived Neurotrophic Factor (BDNF) andNeurotrophin-4/5 (NT4/5) bind to tropmyosin receptor kinase-B (TrkB),and Neurotrophin-3 (NT-3) binds TrkC (and TrkA to a lesser extent)[12-13].

Among neurotrophins, BDNF is the most potent survival factor for injuredRGCs [14-21]. BDNF is a protein molecule produced in the brain andtransported to the retina by way of retrograde axonal transport throughthe optic nerve, where it supports RGCs and maintains their survival[15-21]. In certain conditions, such as during excitotoxic insults withglutamate receptor agonists, such as N-methyl-D-aspartate, BDNF can alsobe produced in RGCs although at relatively low levels [22-23]. BDNF isnormally produced as a prepro-polypeptide (i.e. preproBDNF) containing ashort signal peptide sequence, which facilitates trafficking of theentire polypeptide to vesicles for release into the extracellular space.Cleavage and removal of the signal peptide converts preproBDNF intoproBDNF. An N-terminal proBDNF sequence is then cleaved eitherintracellulary or extracellularly to create mature BDNF (mBDNF) [24].Both pro-BDNF and mBDNF possess biological activity with pro-BDNFpreferentially activating p75^(NTR) receptors and the shorter mBDNFactivating TrkB receptors [25-27]. Activation of P75^(NTR) and TrkBreceptors in the retina show opposing effects on RGC survival, theformer being responsible for apoptosis through directRGC-cell-body-p75^(NTR)-activation [25-28] or indirectly via p75^(NTR)activation on Müller cells, thereby stimulating release of TumourNecrosis Factor-alpha (TNF-α) which further promotes RGC loss [29].

Animal models of glaucoma have demonstrated that following nerve crush,or raised IOP, there is a shift away from neurotrophic mBDNF/TrkBsignalling towards pro-BDNF/p75^(NTR) pathways. Reduced levels of mBDNFand TrkB receptors in the retina have been demonstrated [27, 30-31]together with opposing elevations in the relative levels of pro-BDNF[28] and p75^(NTR) receptors [32]. Supplementation of mBDNF throughocular injections of recombinant protein to rats with experimentallyelevated IOP increases the survival of RGCs compared with untreatedeyes, thereby confirming a key neuroprotective role for thisneurotrophin [19-21].

To maintain levels of mBDNF in eyes with glaucoma, regular injections ofmBDNF would be required as mBDNF is rapidly degraded within the eye. Toovercome the need for regular intraocular injections of mBDNF, attemptsto provide constant elevated BDNF have resorted to using recombinantadenovirus or adeno-associated viral (rAAV) vector delivery of thetransgene coding for BDNF to the retina to delay or prevent RGC death inanimal models of glaucoma [18, 33-34]. rAAV vectors consist of asingle-stranded DNA genome. They have has been successfully used as aviral vector for gene therapy in multiple clinical trials whilstdisplaying limited toxicity. Whilst intravitreal injections ofrecombinant mBDNF alone, or increasing local BDNF production via genetherapy, have been shown to be effective in preventing loss in RGCs overa short period following IOP elevation or other optic nerve damage, thebeneficial effect of BDNF have been shown to be transient [18]. However,gene therapy which incorporates the endogenous BDNF gene sequence isalso capable of producing and releasing pro-BDNF as well as the intendedmBDNF.

Gene therapy aimed at attenuating or preventing loss in TrkB signallingthrough increased expression of the receptor in RGCs or through constantstimulation of remaining extracellular TrkB receptors using an antibodywith agonist properties has also demonstrated success in preventing RGCloss [35-36]. However, reductions in trophic signalling through themBDNF/TrkB pathway is further complicated by internalisation ofmBDNF-activated TrkB receptors and replacement of these receptors at thecell surface with TrkB isoforms incapable of intracellular signalling[37-38]. Furthermore, the biochemical system responsible fordeactivation of TrkB receptors following autophosphorylation of TrkBreceptor dimers in the presence of mBDNF is upregulated in retinassubjected to raised IOP [39].

Furthermore, in addition to glaucoma, the BDNF/TrkB axis has also beenimplicated in neuroprotection of components of the inner ear,specifically of the cochlear structure where insults can result in lossof hair cells resulting in deafness [40-42], and of nerve regeneration[43-44].

There is therefore a need for an improved gene therapy for the treatmentof glaucoma and deafness, and for promoting nerve regeneration orsurvival.

The inventors have constructed a novel genetic construct, which encodesthe tyrosine kinase receptor B (TrkB), and an agonist of the TrkBreceptor under the control of a single promoter. The promoter of theconstruct may be used to ensure that the agonist and the receptor areonly expressed in retinal ganglion cells (RGCs), cochlear or nervecells, and promote the survival of these cells.

Thus, according to a first aspect of the invention, there is provided agenetic construct comprising a promoter operably linked to a firstcoding sequence, which encodes the tyrosine kinase receptor B (TrkB),and a second coding sequence, which encodes an agonist of the TrkBreceptor.

The inventors have demonstrated in the Examples that it is possible tocombine the genes which code for both the TrkB receptor and its agonistin a single genetic construct. This was especially challenging giventheir large sizes, and it could not have been predicted that it wouldhave been possible to co-express them in physiologically usefulconcentrations. Advantageously, with the construct of the invention,there is no need to inject a recombinant protein, as described in theprior art. Furthermore, in the prior art, it is still necessary toperform regular injections of protein, whereas the construct of theinvention only requires a single gene therapy injection.

Preferably, in use, the TrkB receptor is activated by the agonist tothereby promote survival of retinal ganglion cells (RGCs), nerve cellsor cochlear cells. Advantageously, the construct of the invention maytherefore be used to target RGCs, nerve cells or cochlear cells in orderto maintain or enhance TrkB-signalling in these cells. Thus, theconstruct may be used to maximise protection against pathophysiologicalstressors of glaucoma and deafness, and to promote nerve regenerationand/or survival. Furthermore, the construct may be used to providelong-term treatment of glaucoma or deafness due to the expression of theTrkB receptor and an agonist of the receptor under the control of one ormore promoter. Consequently, the construct has overcome the need to usemultiple alternative treatments, which, even in combination, provide atransient therapeutic effect. Moreover, the construct of the inventionis advantageous because it may be used to significantly enhance RGC orcochlear cell sensitivity to TrkB receptor agonists due to a localisedincrease in both the TrkB receptor and the agonist of the receptor.

Preferably, the genetic construct of the invention comprises anexpression cassette, one embodiment of which is shown in FIG. 1. As canbe seen in FIG. 1, the construct comprises the promoter, the firstnucleotide sequence encoding the TrkB receptor, and the secondnucleotide sequence encoding mature brain derived neurotrophic (mBDNF),which acts as a preferred agonist of the TrkB receptor. It will beappreciated, however, that other agonist may be used, as discussedherein. Also as shown in FIG. 1, the expression cassette also includes a2A spacer sequence, a sequence encoding Hepatitis VirusPost-transciptional Regulatory Element (WHPE), a sequence encoding apolyA tail, and left and right hand Inverted Terminal Repeat sequences(ITRs).

Hence, preferably the genetic construct comprises a spacer sequencedisposed between the first and second coding sequences, which spacersequence encodes a peptide spacer that is configured to be digested orcut to thereby produce the TrkB receptor and the agonist as separatemolecules. In the embodiment illustrated in FIG. 1, the coding sequencefor the TrkB receptor is disposed 5′ of the coding sequence for thereceptor agonist (BDNF) with the spacer sequence therebetween. However,in another embodiment, the coding sequence for the receptor agonist maybe disposed 5′ of the coding sequence for the receptor with the spacersequence therebetween.

Preferably, the genetic construct comprises a nucleotide sequenceencoding Woodchuck Hepatitis Virus Post-transcriptional RegulatoryElement (WHPE), which enhances the expression of the two transgenes,i.e. the TrkB receptor and its agonist, which is preferably BDNF.Preferably, the WHPE coding sequence is disposed 3′ of the transgenecoding sequence.

One embodiment of the Woodchuck Hepatitis Virus Post-transcriptionalRegulatory Element (WHPE) is 592 bp long, including gamma-alpha-betaelements, and is referred to herein as SEQ ID No: 57, as follows:

[SEQ ID NO. 57] AATCAACCTCTGGATTACAAAATTTGTGAAAGATTGACTGGTATTCTTAACTATGTTGCTCCTTTTACGCTATGTGGATACGCTGCTTTAATGCCTTTGTATCATGCTATTGCTTCCCGTATGGCTTTCATTTTCTCCTCCTTGTATAAATCCTGGTTGCTGTCTCTTTATGAGGAGTTGTGGCCCGTTGTCAGGCAACGTGGCGTGGTGTGCACTGTGTTTGCTGACGCAACCCCCACTGGTTGGGGCATTGCCACCACCTGTCAGCTCCTTTCCGGGACTTTCGCTTTCCCCCTCCCTATTGCCACGGCGGAACTCATCGCCGCCTGCCTTGCCCGCTGCTGGACAGGGGCTCGGCTGTTGGGCACTGACAATTCCGTGGTGTTGTCGGGGAAGCTGACGTCCTTTCCATGGCTGCTCGCCTGTGTTGCCACCTGGATTCTGCGCGGGACGTCCTTCTGCTACGTCCCTTCGGCCCTCAATCCAGCGGACCTTCCTTCCCGCGGCCTGCTGCCGGCTCTGCGGCCTCTTCCGCGTCTTCGCCTTCGCCCTCAGACGAGTCGGATCTCCCTTTGGGCCGCCTCCCCGCCTG

Preferably, the WHPE comprises a nucleic acid sequence substantially asset out in SEQ ID No: 57, or a fragment or variant thereof.

However, in a preferred embodiment, a truncated WHPE is used, which is247 bp long due to deletion of the beta element, and which is referredto herein as SEQ ID No: 58, as follows:

[SEQ ID NO. 58] AATCAACCTCTGGATTACAAAATTTGTGAAAGATTGACTGGTATTCTTAACTATGTTGCTCCTTTTACGCTATGTGGATACGCTGCTTTAATGCCTTTGTATCATGCTATTGCTTCCCGTATGGCTTTCATTTTCTCCTCCTTGTATAAATCCTGGTTAGTTCTTGCCACGGCGGAACTCATCGCCGCCTGCCTTGCCCGCTGCTGGACAGGGGCTCGGCTGTTGGGCACTGACAATTCCGTGGTGT

Advantageously, the truncated WHPE sequence used in the construct savedabout 300 bp in total without negatively impacting on transgeneexpression. Preferably, the WHPE comprises a nucleic acid sequencesubstantially as set out in SEQ ID No: 58, or a fragment or variantthereof.

Preferably, the genetic construct comprises a nucleotide sequenceencoding a polyA tail. Preferably, the polyA tail coding sequence isdisposed 3′ of the transgene coding sequence, and preferably 3′ of theWHPE coding sequence.

Preferably, the polyA tail comprises the simian virus 40 poly-A 224 bpsequence. One embodiment of the polyA tail is referred to herein as SEQID No: 59, as follows:

[SEQ ID NO. 59] AGCAGACATGATAAGATACATTGATGAGTTTGGACAAACCACAACTAGAATGCAGTGAAAAAAATGCTTTATTTGTGAAATTTGTGATGCTATTGCTTTATTTGTAACCATTATAAGCTGCAATAAACAAGTTAACAACAACAATTGCATTCATTTTATGTTTCAGGTTCAGGGGGAGGTGTGGGAGGTTTTTTAAAGCAAGTAAAACCTCTACAAATGTGGTA

Preferably, the polyA tail comprises a nucleic acid sequencesubstantially as set out in SEQ ID No: 59, or a fragment or variantthereof.

Preferably, the genetic construct comprises left and/or right InvertedTerminal Repeat sequences (ITRs). Preferably, each ITR is disposed atthe 5′ and/or 3′ end of the construct.

The promoter in the genetic construct of the first aspect may be anynucleotide sequence that is capable of inducing RNA polymerase to bindto and transcribe the first and second coding sequences. In onepreferred embodiment, the promoter is the human synapsin I (SYN I)promoter. One embodiment of the 469 nucleotide sequence encoding thehuman synapsin I (SYN I) promoter is referred to herein as SEQ ID NO.1,as follows:

[SEQ ID NO. 1] CTGCAGAGGGCCCTGCGTATGAGTGCAAGTGGGTTTTAGGACCAGGATGAGGCGGGGTGGGGGTGCCTACCTGACGACCGACCCCGACCCACTGGACAAGCACCCAACCCCCATTCCCCAAATTGCGCATCCCCTATCAGAGAGGGGGAGGGGAAACAGGATGCGGCGAGGCGCGTGCGCACTGCCAGCTTCAGCACCGCGGACAGTGCCTTCGCCCCCGCCTGGCGGCGCGCGCCACCGCCGCCTCAGCACTGAAGGCGCGCTGACGTCACTCGCCGGTCCCCCGCAAACTCCCCTTCCCGGCCACCTTGGTCGCGTCCGCGCCGCCGCCGGCCCAGCCGGACCGCACCACGCGAGGCGCGAGATAGGGGGGCACGGGCGCGACCATCTGCGCTGCGGCGCCGGCGACTCAGCGCTGCCTCAGTCTGCGGTGGGCAGCGGAGGAGTCGT GTCGTGCCTGAGAGCGCAG

Preferably, therefore, the promoter may comprise a nucleotide acidsequence substantially as set out in SEQ ID No: 1, or a fragment orvariant thereof.

In another preferred embodiment, the promoter is the CAG promoter. TheCAG promoter preferably comprises the cytomegalovirus early enhancerelement, the first exon and the first intron of chicken beta-actin geneand the splice acceptor of the rabbit beta-globin gene, therebyfacilitating tissue specific expression in RGCs and cochlear cells only.One embodiment of the 1733 nucleotide sequence encoding the CAG promoteris referred to herein as SEQ ID NO.2, as follows:

[SEQ ID NO. 2] CTCGACATTGATTATTGACTAGTTATTAATAGTAATCAATTACGGGGTCATTAGTTCATAGCCCATATATGGAGTTCCGCGTTACATAACTTACGGTAAATGGCCCGCCTGGCTGACCGCCCAACGACCCCCGCCCATTGACGTCAATAATGACGTATGTTCCCATAGTAACGCCAATAGGGACTTTCCATTGACGTCAATGGGTGGAGTATTTACGGTAAACTGCCCACTTGGCAGTACATCAAGTGTATCATATGCCAAGTACGCCCCCTATTGACGTCAATGACGGTAAATGGCCCGCCTGGCATTATGCCCAGTACATGACCTTATGGGACTTTCCTACTTGGCAGTACATCTACGTATTAGTCATCGCTATTACCATGGTCGAGGTGAGCCCCACGTTCTGCTTCACTCTCCCCATCTCCCCCCCCTCCCCACCCCCAATTTTGTATTTATTTATTTTTTAATTATTTTGTGCAGCGATGGGGGCGGGGGGGGGGGGGGGGCGCGCGCCAGGCGGGGCGGGGCGGGGCGAGGGGCGGGGCGGGGCGAGGCGGAGAGGTGCGGCGGCAGCCAATCAGAGCGGCGCGCTCCGAAAGTTTCCTTTTATGGCGAGGCGGCGGCGGCGGCGGCCCTATAAAAAGCGAAGCGCGCGGCGGGCGGGAGTCGCTGCGCGCTGCCTTCGCCCCGTGCCCCGCTCCGCCGCCGCCTCGCGCCGCCCGCCCCGGCTCTGACTGACCGCGTTACTCCCACAGGTGAGCGGGCGGGACGGCCCTTCTCCTCCGGGCTGTAATTAGCGCTTGGTTTAATGACGGCTTGTTTCTTTTCTGTGGCTGCGTGAAAGCCTTGAGGGGCTCCGGGAGGGCCCTTTGTGCGGGGGGAGCGGCTCGGGGGGTGCGTGCGTGTGTGTGTGCGTGGGGAGCGCCGCGTGCGGCTCCGCGCTGCCCGGCGGCTGTGAGCGCTGCGGGCGCGGCGCGGGGCTTTGTGCGCTCCGCAGTGTGCGCGAGGGGAGCGCGGCCGGGGGCGGTGCCCCGCGGTGCGGGGGGGGCTGCGAGGGGAACAAAGGCTGCGTGCGGGGTGTGTGCGTGGGGGGGTGAGCAGGGGGTGTGGGCGCGTCGGTCGGGCTGCAACCCCCCCTGCACCCCCCTCCCCGAGTTGCTGAGCACGGCCCGGCTTCGGGTGCGGGGCTCCGTACGGGGCGTGGCGCGGGGCTCGCCGTGCCGGGCGGGGGGTGGCGGCAGGTGGGGGTGCCGGGCGGGGCGGGGCCGCCTCGGGCCGGGGAGGGCTCGGGGGAGGGGCGCGGCGGCCCCCGGAGCGCCGGCGGCTGTCGAGGCGCGGCGAGCCGCAGCCATTGCCTTTTATGGTAATCGTGCGAGAGGGCGCAGGGACTTCCTTTGTCCCAAATCTGTGCGGAGCCGAAATCTGGGAGGCGCCGCCGCACCCCCTCTAGCGGGCGCGGGGCGAAGCGGTGCGGCGCCGGCAGGAAGGAAATGGGCGGGGAGGGCCTTCGTGCGTCGCCGCGCCGCCGTCCCCTTCTCCCTCTCCAGCCTCGGGGCTGTCCGCGGGGGGACGGCTGCCTTCGGGGGGGACGGGGCAGGGCGGGGTTCGGCTTCTGGCGTGTGACCGGCGGCTCTAGAGCCTCTGCTAACCATGTTCATGCCTTCTTCTTTTTCCTACAGCTCCTGGGCAACGTGCTGGTTATTGTGCTGTCTCATCATTTTGGCAAAGAATTG

In another preferred embodiment, the promoter is a truncated form of theCAG promoter, such as a 664 nucleotide form of the promoter referred toherein as SEQ ID NO.3, as follows:

[SEQ ID No: 3] CTAGATCTGAATTCGGTACCCTAGTTATTAATAGTAATCAATTACGGGGTCATTAGTTCATAGCCCATATATGGAGTTCCGCGTTACATAACTTACGGTAAATGGCCCGCCTGGCTGACCGCCCAACGACCCCCGCCCATTGACGTCAATAATGACGTATGTTCCCATAGTAACGCCAATAGGGACTTTCCATTGACGTCAATGGGTGGACTATTTACGGTAAACTGCCCACTTGGCAGTACATCAAGTGTATCATATGCCAAGTACGCCCCCTATTGACGTCAATGACGGTAAATGGCCCGCCTGGCATTATGCCCAGTACATGACCTTATGGGACTTTCCTACTTGGCAGTACATCTACGTATTAGTCATCGCTATTACCATGGTCGAGGTGAGCCCCACGTTCTGCTTCACTCTCCCCATCTCCCCCCCCTCCCCACCCCCAATTTTGTATTTATTTATTTTTTAATTATTTTGTGCAGCGATGGGGGCGGGGGGGGGGGGGGGGCGCGCGCCAGGCGGGGCGGGGCGGGGCGAGGGGCGGGGCGGGGCGAGGCGGAGAGGTGCGGCGGCAGCCAATCAGAGCGGCGCGCTCCGAAAGTTTCCTTTTATGGCGAGGCGGCGGCGGCGGCGGCCCTATAAAAAGCGAA GCGCGCGGCGGGCG

In yet a further preferred embodiment, the promoter is a truncated formof the CAG promoter, such as a 584 nucleotide form of the promoterreferred to herein as SEQ ID NO. 48, as follows:

[SEQ ID No: 48] GCGTTACATAACTTACGGTAAATGGCCCGCCTGGCTGACCGCCCAACGACCCCCGCCCATTGACGTCAATAATGACGTATGTTCCCATAGTAACGCCAATAGGGACTTTCCATTGACGTCAATGGGTGGACTATTTACGGTAAACTGCCCACTTGGCAGTACATCAAGTGTATCATATGCCAAGTACGCCCCCTATTGACGTCAATGACGGTAAATGGCCCGCCTGGCATTATGCCCAGTACATGACCTTATGGGACTTTCCTACTTGGCAGTACATCTACGTATTAGTCATCGCTATTACCATGGTCGAGGTGAGCCCCACGTTCTGCTTCACTCTCCCCATCTCCCCCCCCTCCCCACCCCCAATTTTGTATTTATTTATTTTTTAATTATTTTGTGCAGCGATGGGGGCGGGGGGGGGGGGGGGGCGCGCGCCAGGCGGGGCGGGGCGGGGCGAGGGGCGGGGCGGGGCGAGGCGGAGAGGTGCGGCGGCAGCCAATCAGAGCGGCGCGCTCCGAAAGTTTCCTTTTATGGCGAGGCGGCGGCGGCGGCGGCCCTATAAAAAGCGAAGCGCGCGGCGGGCG

Therefore, preferably the promoter comprises a nucleotide acid sequencesubstantially as set out in SEQ ID No: 2, 3 or 48, or a fragment orvariant thereof.

Many bicistronic gene constructs presented in the scientific literaturehave either (i) incorporated dual promoters to separately driveexpression of two genes, or (ii) use the internal ribosome entry site(IRES) of the encepahlomyocarditis virus (EMCV) to link two genestranscribed from a single promoter within recombinant viral vectors[45-46]. However, the efficiency of IRES-dependent translation may varyin different cells and tissues and IRES-dependent second gene expressioncan be significantly lower than cap-dependent first gene expression inbicistronic vectors [47]. Moreover, the size limitation of rAAV vectors(generally <5 kb) will prevent the incorporation of large geneconstructs, such as the TrkB receptor together with BDNF using dualpromoters or IRES linkers.

Accordingly, in a preferred embodiment, the genetic construct comprisesa spacer sequence disposed between the first and second codingsequences, which spacer sequence encodes a peptide spacer that isconfigured to be digested to thereby produce the TrkB receptor andagonist as separate molecules. Preferably, the spacer sequence comprisesand encodes a viral peptide spacer sequence, more preferably a viral 2Apeptide spacer sequence [47]. Preferably, the 2A peptide sequenceconnects the first coding sequence to the second coding sequence. Thisenables the construct to overcome the size restrictions that occur withexpression in various vectors and enables expression of all of thepeptides encoded by the construct of the first aspect to occur undercontrol of a single promoter, as a single protein.

Thus, following the translation of the single protein containing thesequences of TrkB, the 2A peptide, and the agonist (preferably BDNF),cleavage occurs in the viral 2A peptide sequence at the terminalglycine-proline link, thereby liberating two proteins, i.e. TrkB andagonist (i.e. mBDNF). The genetic construct is designed such that theremaining short N-terminal amino acid sequence of the viral 2A peptideremain attached to the intracellular portion of the TrkB receptor,thereby removing immunogenicity risks and not interfering with theintracellular signalling capability of the mature receptor. The residualproline amino acid from the C-terminal viral 2A sequence remainsattached to the N-terminal BDNF signal peptide and is ultimately removedfrom the mBDNF protein following cleavage of the signal sequence fromthe mature protein.

The inventors have generated two embodiments of the spacer sequence. Oneimportant section of the peptide spacer sequence, which is common toboth embodiments described herein, is the C-terminus. Accordingly,preferably the peptide spacer sequence comprises an amino acid sequencereferred to herein as SEQ ID NO. 4, or a fragment or variant thereof, asfollows:

[SEQ ID No: 4] QAGDVEENPGP

Preferably, the digestion or cut site of the peptide spacer sequence isdisposed between the terminal glycine and end proline in SEQ ID No:4.

In a first preferred embodiment, the spacer sequence comprises anucleotide sequence referred to herein as SEQ ID NO.5, or a fragment orvariant thereof, as follows:

[SEQ ID No: 5] GGAAGCGGAGCTACTAACTTCAGCCTGCTGAAGGCTGGAGACGTGGAGGAGAACCCTGGACCT

In this first embodiment, the peptide spacer sequence comprises an aminoacid sequence referred to herein as SEQ ID NO. 6, or a fragment orvariant thereof, as follows:

[SEQ ID No: 6] GSGATNFSLLQAGDVEENPGP

In a second preferred embodiment, the spacer sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 7, or a fragment orvariant thereof, as follows:

[SEQ ID No: 7] AGCGGAGCTACTAACTTCAGCCTGCTGAAGCAGGCTGGAGACGTGGAGGAGAACCCTGGACCT

In this second embodiment, the peptide spacer sequence comprises anamino acid sequence referred to herein as SEQ ID NO. 8, or a fragment orvariant thereof, as follows:

[SEQ ID No: 8] SGATNFSLLKQAGDVEENPGP

The inventors have carefully considered the sequences of the TrkBreceptor, and have produced several preferred embodiments of thereceptor that is encoded by the first coding sequence in the geneticconstruct of the first aspect.

In one preferred embodiment, the first coding sequence comprises anucleotide sequence encoding the human canonical isoform of TrkB.Preferably, the canonical isoform of TrkB comprises an amino acidsequence (822 residues) referred to herein as SEQ ID NO. 9, or afragment or variant thereof, as set out below:

[SEQ ID No: 9] MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASRIWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEAYVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRKHFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLNESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDPVPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVAENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKPALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNNGDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYEDYGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVVGFCLLVMLFLLKLARHSKFGMKGPASVISNDDDSASPLHHISNGSNTPSSSEGGPDAVIIGMTKIPVIENPQYFGITNSQLKPDTFVQHIKRHNIVLKRELGEGAFGKVFLAECYNLCPEQDKILVAVKTLKDASDNARKDFHREAELLTNLQHEHIVKFYGVCVEGDPLIMVFEYMKHGDLNKFLRAHGPDAVLMAEGNPPTELTQSQMLHIAQQIAAGMVYLASQHFVHRDLATRNCLVGENLLVKIGDFGMSRDVYSTDYYRVGGHTMLPIRWMPPESIMYRKFTTESDVWSLGVVLWEIFTYGKQPWYQLSNNEVIECITQGRVLQRPRTCPQEVYELMLGCWQREPHMRKNIKGIHTLLQNLAKASPVYLDILG

Preferably, in this embodiment, the first coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 10, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 10] ATGTCGTCCTGGATAAGGTGGCATGGACCCGCCATGGCGCGGCTCTGGGGCTTCTGCTGGCTGGTTGTGGGCTTCTGGAGGGCCGCTTTCGCCTGTCCCACGTCCTGCAAATGCAGTGCCTCTCGGATCTGGTGCAGCGACCCTTCTCCTGGCATCGTGGCATTTCCGAGATTGGAGCCTAACAGTGTAGATCCTGAGAACATCACCGAAATTTTCATCGCAAACCAGAAAAGGTTAGAAATCATCAACGAAGATGATGTTGAAGCTTATGTGGGACTGAGAAATCTGACAATTGTGGATTCTGGATTAAAATTTGTGGCTCATAAAGCATTTCTGAAAAACAGCAACCTGCAGCACATCAATTTTACCCGAAACAAACTGACGAGTTTGTCTAGGAAACATTTCCGTCACCTTGACTTGTCTGAACTGATCCTGGTGGGCAATCCATTTACATGCTCCTGTGACATTATGTGGATCAAGACTCTCCAAGAGGCTAAATCCAGTCCAGACACTCAGGATTTGTACTGCCTGAATGAAAGCAGCAAGAATATTCCCCTGGCAAACCTGCAGATACCCAATTGTGGTTTGCCATCTGCAAATCTGGCCGCACCTAACCTCACTGTGGAGGAAGGAAAGTCTATCACATTATCCTGTAGTGTGGCAGGTGATCCGGTTCCTAATATGTATTGGGATGTTGGTAACCTGGTTTCCAAACATATGAATGAAACAAGCCACACACAGGGCTCCTTAAGGATAACTAACATTTCATCCGATGACAGTGGGAAGCAGATCTCTTGTGTGGCGGAAAATCTTGTAGGAGAAGATCAAGATTCTGTCAACCTCACTGTGCATTTTGCACCAACTATCACATTTCTCGAATCTCCAACCTCAGACCACCACTGGTGCATTCCATTCACTGTGAAAGGCAACCCCAAACCAGCGCTTCAGTGGTTCTATAACGGGGCAATATTGAATGAGTCCAAATACATCTGTACTAAAATACATGTTACCAATCACACGGAGTACCACGGCTGCCTCCAGCTGGATAATCCCACTCACATGAACAATGGGGACTACACTCTAATAGCCAAGAATGAGTATGGGAAGGATGAGAAACAGATTTCTGCTCACTTCATGGGCTGGCCTGGAATTGACGATGGTGCAAACCCAAATTATCCTGATGTAATTTATGAAGATTATGGAACTGCAGCGAATGACATCGGGGACACCACGAACAGAAGTAATGAAATCCCTTCCACAGACGTCACTGATAAAACCGGTCGGGAACATCTCTCGGTCTATGCTGTGGTGGTGATTGCGTCTGTGGTGGGATTTTGCCTTTTGGTAATGCTGTTTCTGCTTAAGTTGGCAAGACACTCCAAGTTTGGCATGAAAGGCCCAGCCTCCGTTATCAGCAATGATGATGACTCTGCCAGCCCACTCCATCACATCTCCAATGGGAGTAACACTCCATCTTCTTCGGAAGGTGGCCCAGATGCTGTCATTATTGGAATGACCAAGATCCCTGTCATTGAAAATCCCCAGTACTTTGGCATCACCAACAGTCAGCTCAAGCCAGACACATTTGTTCAGCACATCAAGCGACATAACATTGTTCTGAAAAGGGAGCTAGGCGAAGGAGCCTTTGGAAAAGTGTTCCTAGCTGAATGCTATAACCTCTGTCCTGAGCAGGACAAGATCTTGGTGGCAGTGAAGACCCTGAAGGATGCCAGTGACAATGCACGCAAGGACTTCCACCGTGAGGCCGAGCTCCTGACCAACCTCCAGCATGAGCACATCGTCAAGTTCTATGGCGTCTGCGTGGAGGGCGACCCCCTCATCATGGTCTTTGAGTACATGAAGCATGGGGACCTCAACAAGTTCCTCAGGGCACACGGCCCTGATGCCGTGCTGATGGCTGAGGGCAACCCGCCCACGGAACTGACGCAGTCGCAGATGCTGCATATAGCCCAGCAGATCGCCGCGGGCATGGTCTACCTGGCGTCCCAGCACTTCGTGCACCGCGATTTGGCCACCAGGAACTGCCTGGTCGGGGAGAACTTGCTGGTGAAAATCGGGGACTTTGGGATGTCCCGGGACGTGTACAGCACTGACTACTACAGGGTCGGTGGCCACACAATGCTGCCCATTCGCTGGATGCCTCCAGAGAGCATCATGTACAGGAAATTCACGACGGAAAGCGACGTCTGGAGCCTGGGGGTCGTGTTGTGGGAGATTTTCACCTATGGCAAACAGCCCTGGTACCAGCTGTCAAACAATGAGGTGATAGAGTGTATCACTCAGGGCCGAGTCCTGCAGCGACCCCGCACGTGCCCCCAGGAGGTGTATGAGCTGATGCTGGGGTGCTGGCAGCGAGAGCCCCACATGAGGAAGAACATCAAGGGCATCCATACCCTCCTTCAGAACTTGGCCAAGGCATCTCCGGTCTA CCTGGACATTCTAGGC

In another preferred embodiment, the first coding sequence comprises anucleotide sequence which encodes isoform 4 of TrkB. Preferably, isoform4 of TrkB comprises an amino acid sequence referred to herein as SEQ IDNO. 11, or a fragment or variant thereof, as set out below:

[SEQ ID No: 11] MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASRIWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEAYVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRKHFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLNESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDPVPNMYWDVGNLVSKHMNETSHTOGSLRITNISSDDSGKQISCVAENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKPALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNNGDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYEDYGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVVGFCLLVMLFLLKLARHSKFGMKDFSWFGFGKVKSRQGVGPASVISNDDDSASPLHHISNGSNTPSSSEGGPDAVIIGMTKIPVIENPQYFGITNSQLKPDTFVQHIKRHNIVLKRELGEGAFGKVFLAECYNLCPEQDKILVAVKTLKDASDNARKDFHREAELLTNLQHEHIVKFYGVCVEGDPLIMVFEYMKHGDLNKFLRAHGPDAVLMAEGNPPTELTQSQMLHIAQQIAAGMVYLASQHFVHRDLATRNCLVGENLLVKIGDFGMSRDVYSTDYYRVGGHTMLPIRWMPPESIMYRKFTTESDVWSLGVVLWEIFTYGKQPWYQLSNNEVIECITQGRVLQRPRTCPQEVYELMLGCWQREPHMRKNIKGIHTLLQNLAKASPVYLDILG

Preferably, this embodiment of the first coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 12, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 12] ATGTCGTCCTGGATAAGGTGGCATGGACCCGCCATGGCGCGGCTCTGGGGCTTCTGCTGGCTGGTTGTGGGCTTCTGGAGGGCCGCTTTCGCCTGTCCCACGTCCTGCAAATGCAGTGCCTCTCGGATCTGGTGCAGCGACCCTTCTCCTGGCATCGTGGCATTTCCGAGATTGGAGCCTAACAGTGTAGATCCTGAGAACATCACCGAAATTTTCATCGCAAACCAGAAAAGGTTAGAAATCATCAACGAAGATGATGTTGAAGCTTATGTGGGACTGAGAAATCTGACAATTGTGGATTCTGGATTAAAATTTGTGGCTCATAAAGCATTTCTGAAAAACAGCAACCTGCAGCACATCAATTTTACCCGAAACAAACTGACGAGTTTGTCTAGGAAACATTTCCGTCACCTTGACTTGTCTGAACTGATCCTGGTGGGCAATCCATTTACATGCTCCTGTGACATTATGTGGATCAAGACTCTCCAAGAGGCTAAATCCAGTCCAGACACTCAGGATTTGTACTGCCTGAATGAAAGCAGCAAGAATATTCCCCTGGCAAACCTGCAGATACCCAATTGTGGTTTGCCATCTGCAAATCTGGCCGCACCTAACCTCACTGTGGAGGAAGGAAAGTCTATCACATTATCCTGTAGTGTGGCAGGTGATCCGGTTCCTAATATGTATTGGGATGTTGGTAACCTGGTTTCCAAACATATGAATGAAACAAGCCACACACAGGGCTCCTTAAGGATAACTAACATTTCATCCGATGACAGTGGGAAGCAGATCTCTTGTGTGGCGGAAAATCTTGTAGGAGAAGATCAAGATTCTGTCAACCTCACTGTGCATTTTGCACCAACTATCACATTTCTCGAATCTCCAACCTCAGACCACCACTGGTGCATTCCATTCACTGTGAAAGGCAACCCCAAACCAGCGCTTCAGTGGTTCTATAACGGGGCAATATTGAATGAGTCCAAATACATCTGTACTAAAATACATGTTACCAATCACACGGAGTACCACGGCTGCCTCCAGCTGGATAATCCCACTCACATGAACAATGGGGACTACACTCTAATAGCCAAGAATGAGTATGGGAAGGATGAGAAACAGATTTCTGCTCACTTCATGGGCTGGCCTGGAATTGACGATGGTGCAAACCCAAATTATCCTGATGTAATTTATGAAGATTATGGAACTGCAGCGAATGACATCGGGGACACCACGAACAGAAGTAATGAAATCCCTTCCACAGACGTCACTGATAAAACCGGTCGGGAACATCTCTCGGTCTATGCTGTGGTGGTGATTGCGTCTGTGGTGGGATTTTGCCTTTTGGTAATGCTGTTTCTGCTTAAGTTGGCAAGACACTCCAAGTTTGGCATGAAAGATTTCTCATGGTTTGGATTTGGGAAAGTAAAATCAAGACAAGGTGTTGGCCCAGCCTCCGTTATCAGCAATGATGATGACTCTGCCAGCCCACTCCATCACATCTCCAATGGGAGTAACACTCCATCTTCTTCGGAAGGTGGCCCAGATGCTGTCATTATTGGAATGACCAAGATCCCTGTCATTGAAAATCCCCAGTACTTTGGCATCACCAACAGTCAGCTCAAGCCAGACACATTTGTTCAGCACATCAAGCGACATAACATTGTTCTGAAAAGGGAGCTAGGCGAAGGAGCCTTTGGAAAAGTGTTCCTAGCTGAATGCTATAACCTCTGTCCTGAGCAGGACAAGATCTTGGTGGCAGTGAAGACCCTGAAGGATGCCAGTGACAATGCACGCAAGGACTTCCACCGTGAGGCCGAGCTCCTGACCAACCTCCAGCATGAGCACATCGTCAAGTTCTATGGCGTCTGCGTGGAGGGCGACCCCCTCATCATGGTCTTTGAGTACATGAAGCATGGGGACCTCAACAAGTTCCTCAGGGCACACGGCCCTGATGCCGTGCTGATGGCTGAGGGCAACCCGCCCACGGAACTGACGCAGTCGCAGATGCTGCATATAGCCCAGCAGATCGCCGCGGGCATGGTCTACCTGGCGTCCCAGCACTTCGTGCACCGCGATTTGGCCACCAGGAACTGCCTGGTCGGGGAGAACTTGCTGGTGAAAATCGGGGACTTTGGGATGTCCCGGGACGTGTACAGCACTGACTACTACAGGGTCGGTGGCCACACAATGCTGCCCATTCGCTGGATGCCTCCAGAGAGCATCATGTACAGGAAATTCACGACGGAAAGCGACGTCTGGAGCCTGGGGGTCGTGTTGTGGGAGATTTTCACCTATGGCAAACAGCCCTGGTACCAGCTGTCAAACAATGAGGTGATAGAGTGTATCACTCAGGGCCGAGTCCTGCAGCGACCCCGCACGTGCCCCCAGGAGGTGTATGAGCTGATGCTGGGGTGCTGGCAGCGAGAGCCCCACATGAGGAAGAACATCAAGGGCATCCATACCCTCCTTCAGAACTTGGCCAAGGCATCTCCGGTCTACC TGGACATTCTAGGC

The inventors have spent considerable inventive endeavour in studyingthe sequence of the TrkB receptor and have realised that TrkB comprisesfive tyrosine residues (at position 516, 701, 705, 706 and 816 of SEQ IDNo: 9), which are normally phosphorylated following dimerization andautophosphorylation in the presence of a BDNF dimer. A problem withphosphorylation of these five tyrosine residues is that the receptor canbe readily deactivated by a phosphatase, such as the Shp-2 phosphatase.Accordingly, in order to prevent phosphorylation and resultantdeactivation of the receptor in vivo, preferably one or more of thesekey tyrosines is mutated (more preferably, to glutamic acid) in order tomimic the resultant phosphotyrosine and produce a receptor which remainsactive in the presence of BDNF, and which cannot be deactivated by aphosphatise, such as the Shp-2 phosphatase. Such mutant forms of TrkBare aimed at producing TrkB receptor activity which remains active forlonger periods, or until the receptor is internalised.

The DNA and amino acid sequences provided below illustrate the positionsof these five tyrosine (Y) residues which have been mutated into fiveglutamic acid (E) residues. It will be appreciated that 1, 2, 3, 4 or 5of these residues may be mutated to glutamic acid in embodiments of theinvention. Various combinations of these mutations is also envisaged,e.g. positions 516 and 701 only, or positions 705, 706 and 816 only, andso on.

Accordingly, in another preferred embodiment, the first coding sequencecomprises a nucleotide sequence encoding a mutant form of TrkB receptor,wherein one or more tyrosine residue at position 516, 701, 705, 706and/or 816 of SEQ ID No: 9 is modified or mutated. Preferably, at leasttwo, three or four tyrosine residues at position 516, 701, 705, 706and/or 816 of SEQ ID No: 9 are modified. Most preferably, all fivetyrosine residues at position 516, 701, 705, 706 and/or 816 of SEQ IDNo: 9 are modified.

Preferably, the or each tyrosine residue is modified to a differentamino acid residue, more preferably a glutamic acid. Thus, preferablythe mutant form of the TrkB receptor comprises Y516E, Y701E, Y705E,Y706E and/or Y816E.

Preferably, the modified form of the TrkB receptor comprises an aminoacid sequence referred to herein as SEQ ID NO. 13, or a fragment orvariant thereof, as set out below:

[SEQ ID No: 13] MSSWIRWHGPAMARLWGFCWLVVGFWRAAFACPTSCKCSASRIWCSDPSPGIVAFPRLEPNSVDPENITEIFIANQKRLEIINEDDVEAYVGLRNLTIVDSGLKFVAHKAFLKNSNLQHINFTRNKLTSLSRKHFRHLDLSELILVGNPFTCSCDIMWIKTLQEAKSSPDTQDLYCLNESSKNIPLANLQIPNCGLPSANLAAPNLTVEEGKSITLSCSVAGDPVPNMYWDVGNLVSKHMNETSHTQGSLRITNISSDDSGKQISCVAENLVGEDQDSVNLTVHFAPTITFLESPTSDHHWCIPFTVKGNPKPALQWFYNGAILNESKYICTKIHVTNHTEYHGCLQLDNPTHMNNGDYTLIAKNEYGKDEKQISAHFMGWPGIDDGANPNYPDVIYEDYGTAANDIGDTTNRSNEIPSTDVTDKTGREHLSVYAVVVIASVVGFCLLVMLFLLKLARHSKFGMKGPASVISNDDDSASPLHHISNGSNTPSSSEGGPDAVIIGMTKIPVIENPQEFGITNSQLKPDTFVQHIKRHNIVLKRELGEGAFGKVFLAECYNLCPEQDKILVAVKTLKDASDNARKDFHREAELLTNLQHEHIVKFYGVCVEGDPLIMVFEYMKHGDLNKFLRAHGPDAVLMAEGNPPTELTQSQMLHIAQQIAAGMVYLASQHFVHRDLATRNCLVGENLLVKIGDFGMSRDVESTDEERVGGHTMLPIRWMPPESIMYRKFTTESDVWSLGVVLWEIFTYGKQPWYQLSNNEVIECITQGRVLQRPRTCPQEVYELMLGCWQREPHMRKNIKGIHTLLQNLAKASPVELDILG

Preferably, in this embodiment, the first coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 14, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 14] ATGTCGTCCTGGATAAGGTGGCATGGACCCGCCATGGCGCGGCTCTGGGGCTTCTGCTGGCTGGTTGTGGGCTTCTGGAGGGCCGCTTTCGCCTGTCCCACGTCCTGCAAATGCAGTGCCTCTCGGATCTGGTGCAGCGACCCTTCTCCTGGCATCGTGGCATTTCCGAGATTGGAGCCTAACAGTGTAGATCCTGAGAACATCACCGAAATTTTCATCGCAAACCAGAAAAGGTTAGAAATCATCAACGAAGATGATGTTGAAGCTTATGTGGGACTGAGAAATCTGACAATTGTGGATTCTGGATTAAAATTTGTGGCTCATAAAGCATTTCTGAAAAACAGCAACCTGCAGCACATCAATTTTACCCGAAACAAACTGACGAGTTTGTCTAGGAAACATTTCCGTCACCTTGACTTGTCTGAACTGATCCTGGTGGGCAATCCATTTACATGCTCCTGTGACATTATGTGGATCAAGACTCTCCAAGAGGCTAAATCCAGTCCAGACACTCAGGATTTGTACTGCCTGAATGAAAGCAGCAAGAATATTCCCCTGGCAAACCTGCAGATACCCAATTGTGGTTTGCCATCTGCAAATCTGGCCGCACCTAACCTCACTGTGGAGGAAGGAAAGTCTATCACATTATCCTGTAGTGTGGCAGGTGATCCGGTTCCTAATATGTATTGGGATGTTGGTAACCTGGTTTCCAAACATATGAATGAAACAAGCCACACACAGGGCTCCTTAAGGATAACTAACATTTCATCCGATGACAGTGGGAAGCAGATCTCTTGTGTGGCGGAAAATCTTGTAGGAGAAGATCAAGATTCTGTCAACCTCACTGTGCATTTTGCACCAACTATCACATTTCTCGAATCTCCAACCTCAGACCACCACTGGTGCATTCCATTCACTGTGAAAGGCAACCCCAAACCAGCGCTTCAGTGGTTCTATAACGGGGCAATATTGAATGAGTCCAAATACATCTGTACTAAAATACATGTTACCAATCACACGGAGTACCACGGCTGCCTCCAGCTGGATAATCCCACTCACATGAACAATGGGGACTACACTCTAATAGCCAAGAATGAGTATGGGAAGGATGAGAAACAGATTTCTGCTCACTTCATGGGCTGGCCTGGAATTGACGATGGTGCAAACCCAAATTATCCTGATGTAATTTATGAAGATTATGGAACTGCAGCGAATGACATCGGGGACACCACGAACAGAAGTAATGAAATCCCTTCCACAGACGTCACTGATAAAACCGGTCGGGAACATCTCTCGGTCTATGCTGTGGTGGTGATTGCGTCTGTGGTGGGATTTTGCCTTTTGGTAATGCTGTTTCTGCTTAAGTTGGCAAGACACTCCAAGTTTGGCATGAAAGGCCCAGCCTCCGTTATCAGCAATGATGATGACTCTGCCAGCCCACTCCATCACATCTCCAATGGGAGTAACACTCCATCTTCTTCGGAAGGTGGCCCAGATGCTGTCATTATTGGAATGACCAAGATCCCTGTCATTGAAAATCCCCAGGAATTTGGCATCACCAACAGTCAGCTCAAGCCAGACACATTTGTTCAGCACATCAAGCGACATAACATTGTTCTGAAAAGGGAGCTAGGCGAAGGAGCCTTTGGAAAAGTGTTCCTAGCTGAATGCTATAACCTCTGTCCTGAGCAGGACAAGATCTTGGTGGCAGTGAAGACCCTGAAGGATGCCAGTGACAATGCACGCAAGGACTTCCACCGTGAGGCCGAGCTCCTGACCAACCTCCAGCATGAGCACATCGTCAAGTTCTATGGCGTCTGCGTGGAGGGCGACCCCCTCATCATGGTCTTTGAGTACATGAAGCATGGGGACCTCAACAAGTTCCTCAGGGCACACGGCCCTGATGCCGTGCTGATGGCTGAGGGCAACCCGCCCACGGAACTGACGCAGTCGCAGATGCTGCATATAGCCCAGCAGATCGCCGCGGGCATGGTCTACCTGGCGTCCCAGCACTTCGTGCACCGCGATTTGGCCACCAGGAACTGCCTGGTCGGGGAGAACTTGCTGGTGAAAATCGGGGACTTTGGGATGTCCCGGGACGTGGAAAGCACTGACGAAGAAAGGGTCGGTGGCCACACAATGCTGCCCATTCGCTGGATGCCTCCAGAGAGCATCATGTACAGGAAATTCACGACGGAAAGCGACGTCTGGAGCCTGGGGGTCGTGTTGTGGGAGATTTTCACCTATGGCAAACAGCCCTGGTACCAGCTGTCAAACAATGAGGTGATAGAGTGTATCACTCAGGGCCGAGTCCTGCAGCGACCCCGCACGTGCCCCCAGGAGGTGTATGAGCTGATGCTGGGGTGCTGGCAGCGAGAGCCCCACATGAGGAAGAACATCAAGGGCATCCATACCCTCCTTCAGAACTTGGCCAAGGCATCTCCGGTCGA ACTGGACATTCTAGGC

It will be appreciated that the second coding sequence encodes anagonist of the TrkB receptor, which is preferably a member of theneurotrophin family of trophic factors. Preferred agonists of the TrkBreceptor may therefore be selected from a group of agonists consistingof: Brain-derived neurotrophic factor (BDNF); nerve growth factor (NGF);neurotrophin-3 (NT-3); neurotrophin-4 (NT-4); and neurotrophin-5 (NT-5);or fragments thereof.

The nucleotide and amino acid sequences of each of these agonists willbe known to the skilled person. However, by way of example, the aminoacid sequence of one embodiment of Neurotrophin-4 (NT-4) issubstantially as set out in SEQ ID NO. 49, as follows:

[SEQ ID No: 49] MLPLPSCSLPILLLFLLPSVPIESQPPPSTLPPFLAPEWDLLSPRVVLSRGAPAGPPLLFLLEAGAFRESAGAPANRSRRGVSETAPASRRGELAVCDAVSGWVTDRRTAVDLRGREVEVLGEVPAAGGSPLRQYFFETRCKADNAEEGGPGAGGGGCRGVDRRHWVSECKAKQSYVRALTADAQGRVGWRWIRIDTACV CTLLSRTGRA

The nucleic acid coding sequence of this embodiment of Neurotrophin-4(NT-4) is substantially as set out in SEQ ID NO. 50, as follows:

[SEQ ID No: 50] ATGCTCCCTCTCCCCTCATGCTCCCTCCCCATCCTCCTCCTTTTCCTCCTCCCCAGTGTGCCAATTGAGTCCCAACCCCCACCCTCAACATTGCCCCCTTTTCTGGCCCCTGAGTGGGACCTTCTCTCCCCCCGAGTAGTCCTGTCTAGGGGTGCCCCTGCTGGGCCCCCTCTGCTCTTCCTGCTGGAGGCTGGGGCCTTTCGGGAGTCAGCAGGTGCCCCGGCCAACCGCAGCCGGCGTGGGGTGAGCGAAACTGCACCAGCGAGTCGTCGGGGTGAGCTGGCTGTGTGCGATGCAGTCAGTGGCTGGGTGACAGACCGCCGGACCGCTGTGGACTTGCGTGGGCGCGAGGTGGAGGTGTTGGGCGAGGTGCCTGCAGCTGGCGGCAGTCCCCTCCGCCAGTACTTCTTTGAAACCCGCTGCAAGGCTGATAACGCTGAGGAAGGTGGCCCGGGGGCAGGTGGAGGGGGCTGCCGGGGAGTGGACAGGAGGCACTGGGTATCTGAGTGCAAGGCCAAGCAGTCCTATGTGCGGGCATTGACCGCTGATGCCCAGGGCCGTGTGGGCTGGCGATGGATTCGAATTGACACTGCCTGCGTCTGCACACTCCTCAGCCGGACTGGCCGGGCC

The amino acid sequence of the signal peptide for the NT-4 sequence issubstantially as set out in SEQ ID NO. 51, as follows:

[SEQ ID No: 51] MLPLPSCSLPILLLFLLPSVPIES

The nucleic acid sequence of this signal peptide is substantially as setout in SEQ ID NO. 52, as follows:

[SEQ ID No: 52] ATGCTCCCTCTCCCCTCATGCTCCCTCCCCATCCTCCTCCTTTTCCTCCTCCCCAGTGTGCCAATTGAGTCC

The amino acid sequence of the propeptide for this NT-4 sequence issubstantially as set out in SEQ ID NO. 53, as follows:

[SEQ ID No: 53] QPPPSTLPPFLAPEWDLLSPRVVLSRGAPAGPPLLFLLEAGAFRESAGAPANRSRR

The nucleic acid sequence of this propeptide is substantially as set outin SEQ ID NO. 54, as follows:

[SEQ ID No: 54] CAACCCCCACCCTCAACATTGCCCCCTTTTCTGGCCCCTGAGTGGGACCTTCTCTCCCCCCGAGTAGTCCTGTCTAGGGGTGCCCCTGCTGGGCCCCCTCTGCTCTTCCTGCTGGAGGCTGGGGCCTTTCGGGAGTCAGCAGGTGCCCCG GCCAACCGCAGCCGGCGT

The amino acid sequence of the mature protein sequence for this NT-4sequence is substantially as set out in SEQ ID NO. 55, as follows:

[SEQ ID No: 55] GVSETAPASRRGELAVCDAVSGWVTDRRTAVDLRGREVEVLGEVPAAGGSPLRQYFFETRCKADNAEEGGPGAGGGGCRGVDRRHWVSECKAKQSYVRALTADAQGRVGWRWIRIDTACVCTLLSRTGRA

The nucleic acid coding sequence of this mature NT-4 protein issubstantially as set out in SEQ ID NO. 56, as follows:

[SEQ ID No: 56] GGGGTGAGCGAAACTGCACCAGCGAGTCGTCGGGGTGAGCTGGCTGTGTGCGATGCAGTCAGTGGCTGGGTGACAGACCGCCGGACCGCTGTGGACTTGCGTGGGCGCGAGGTGGAGGTGTTGGGCGAGGTGCCTGCAGCTGGCGGCAGTCCCCTCCGCCAGTACTTCTTTGAAACCCGCTGCAAGGCTGATAACGCTGAGGAAGGTGGCCCGGGGGCAGGTGGAGGGGGCTGCCGGGGAGTGGACAGGAGGCACTGGGTATCTGAGTGCAAGGCCAAGCAGTCCTATGTGCGGGCATTGACCGCTGATGCCCAGGGCCGTGTGGGCTGGCGATGGATTCGAATTGACACTGCCTGCGTCTGCACACTCCTCAGCCGGACTGGCCGGGCC

Accordingly, in one preferred embodiment, the second coding sequenceencodes neurotrophin-4 (NT-4), which may comprise an amino acid sequencesubstantially as set out in SEQ ID NO: 49 or 55, or fragment or variantthereof. Thus, the second coding sequence may comprise a nucleotidesequence substantially as set out in SEQ ID No: 50 or 56, or a fragmentor variant thereof.

Most preferred agonists of the TrkB receptor, however, includeprepro-brain derived neurotrophic factor (pre-pro-BDNF), pro-BDNF ormature BDNF (mBDNF). BDNF is initially synthesised as the precursorprotein, preproBDNF, by ribosomes found on endoplasmic reticulum. Thereare at least 17 known splice variants encoded by the human preproBDNFgene (ENSG00000176697). Once preproBDNF has entered into the roughendoplasmic reticulum, preproBDNF is converted into proBDNF by cleavageof the signal peptide (i.e. the “pre” sequence). proBDNF is convertedinto mBDNF by cleavage of an additional N-terminal peptide sequence thatis present on proBDNF. Both proBDNF and mBDNF are then secreted into theextracellular space, where they bind to and activate receptors onvarious cells, including RGCs and cochlear cells.

proBDNF preferentially binds to and activates the receptor, p75^(NTR),which, when activated, induces apoptosis in RGCs and cochlear cells.Thus, in one preferred embodiment, proBDNF is an agonist of thep75^(NTR) receptor. In one embodiment, the proBDNF is canonical proBDNF.Preferably, canonical proBDNF comprises an amino acid sequence referredto herein as SEQ ID NO. 15, or a fragment or variant thereof, as set outbelow:

[SEQ ID No: 15] APMKEANIRGQGGLAYPGVRTHGTLESVNGPKAGSRGLTSLADTFEHVIEELLDEDQKVRPNEENNKDADLYTSRVMLSSQVPLEPPLLFLLEEYKNYLDAANMSMRVRRHSDPARRGELSVCDSISEWVTAADKKTAVDMSGGTVTVLEKVPVSKGQLKQYFYETKCNPMGYTKEGCRGIDKRHWNSQCRTTQSYVRALTMDSKKRIGWRFIRIDTSCVCTLTIKRGR

Preferably, in this embodiment, the second coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 16, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 16] GCCCCCATGAAAGAAGCAAACATCCGAGGACAAGGTGGCTTGGCCTACCCAGGTGTGCGGACCCATGGGACTCTGGAGAGCGTGAATGGGCCCAAGGCAGGTTCAAGAGGCTTGACATCATTGGCTGACACTTTCGAACACGTGATAGAAGAGCTGTTGGATGAGGACCAGAAAGTTCGGCCCAATGAAGAAAACAATAAGGACGCAGACTTGTACACGTCCAGGGTGATGCTCAGTAGTCAAGTGCCTTTGGAGCCTCCTCTTCTCTTTCTGCTGGAGGAATACAAAAATTACCTAGATGCTGCAAACATGTCCATGAGGGTCCGGCGCCACTCTGACCCTGCCCGCCGAGGGGAGCTGAGCGTGTGTGACAGTATTAGTGAGTGGGTAACGGCGGCAGACAAAAAGACTGCAGTGGACATGTCGGGCGGGACGGTCACAGTCCTTGAAAAGGTCCCTGTATCAAAAGGCCAACTGAAGCAATACTTCTACGAGACCAAGTGCAATCCCATGGGTTACACAAAAGAAGGCTGCAGGGGCATAGACAAAAGGCATTGGAACTCCCAGTGCCGAACTACCCAGTCGTACGTGCGGGCCCTTACCATGGATAGCAAAAAGAGAATTGGCTGGCGATTCATAAGGATAGACACTTCTTGTGTATGTACATTGACCATTAAAAGGGGAAGATAG

In another embodiment, the proBDNF is isoform 2 of proBDNF, whichpreferably comprises a Valine to methionione mutation (amino acidunderlined). Preferably, isoform 2 of proBDNF comprises an amino acidsequence referred to herein as SEQ ID NO. 17, or a fragment or variantthereof, as set out below:

[SEQ ID No: 17] APMKEANIRGQGGLAYPGVRTHGTLESVNGPKAGSRGLTSLADTFEHMIEELLDEDQKVRPNEENNKDADLYTSRVMLSSQVPLEPPLLFLLEEYKNYLDAANMSMRVRRHSDPARRGELSVCDSISEWVTAADKKTAVDMSGGTVTVLEKVPVSKGQLKQYFYETKCNPMGYTKEGCRGIDKRHWNSQCRTTQSYVRALTMDSKKRIGWRFIRIDTSCVCTLTIKRGR

In one embodiment, however, the agonist is not proBDNF, or a fragment orvariant thereof, but instead the second coding sequence preferablycomprises a nucleotide sequence which encodes mature BDNF. Mature BDNF(mBDNF) preferentially binds to, and activates, TrkB, which, whenactivated, promotes survival of RGCs and/or cochlear cells. Thus, matureBDNF is a most preferred agonist of TrkB. The construct according to thefirst aspect is advantageous because, unlike other known geneticconstructs, the construct is capable of producing mature BDNF protein,which has not been mis-folded.

Thus, in one preferred embodiment, the second coding sequence comprisesa nucleotide sequence which encodes mature BDNF. mBDNF is common to all17 isoforms encoded by the gene. There 7 protein different sequences,five of which have extended signal sequences to the canonical form, andone has a canonical signal sequence, but a Valine to Methionine mutation(which is common to isoforms 2, 4, 7, 8, 9, 10, 11, 12, 13, 14 and 16).It is believed that the valine to methionine mutation reduces release ofBDNF from the cell.

Preferably, mature BDNF comprises an amino acid sequence referred toherein as SEQ ID NO. 18, or a fragment or variant thereof, as set outbelow:

[SEQ ID No: 18] HSDPARRGELSVCDSISEWVTAADKKTAVDMSGGTVTVLEKVPVSKGQLKQYFYETKCNPMGYTKEGCRGIDKRHWNSQCRTTQSYVRALTMDSKKRIGW RFIRIDTSCVCTLTIKRGR

Preferably, this embodiment of the second coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 19, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 19] ATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTTGGTTGCATGAAGGCTGCCCCCATGAAAGAAGCAAACATCCGAGGACAAGGTGGCTTGGCCTACCCAGGTGTGCGGACCCATGGGACTCTGGAGAGCGTGAATGGGCCCAAGGCAGGTTCAAGAGGCTTGACATCATTGGCTGACACTTTCGAACACGTGATAGAAGAGCTGTTGGATGAGGACCAGAAAGTTCGGCCCAATGAAGAAAACAATAAGGACGCAGACTTGTACACGTCCAGGGTGATGCTCAGTAGTCAAGTGCCTTTGGAGCCTCCTCTTCTCTTTCTGCTGGAGGAATACAAAAATTACCTAGATGCTGCAAACATGTCCATGAGGGTCCGGCGCCACTCTGACCCTGCCCGCCGAGGGGAGCTGAGCGTGTGTGACAGTATTAGTGAGTGGGTAACGGCGGCAGACAAAAAGACTGCAGTGGACATGTCGGGCGGGACGGTCACAGTCCTTGAAAAGGTCCCTGTATCAAAAGGCCAACTGAAGCAATACTTCTACGAGACCAAGTGCAATCCCATGGGTTACACAAAAGAAGGCTGCAGGGGCATAGACAAAAGGCATTGGAACTCCCAGTGCCGAACTACCCAGTCGTACGTGCGGGCCCTTACCATGGATAGCAAAAAGAGAATTGGCTGGCGATTCATAAGGATAGACACTTCTTGTGTATGTACATTGACCATTAAAAGGGGAAGATAG

In yet another preferred embodiment, the agonist is mBDNF with a signalpeptide conjugated to its N-terminus. As discussed below, the signalpeptide may be canonical signal peptide of preproBDNF, or the signalpeptide of IL-2, or a de novo novel signal sequence created by theinventors.

Preferably, the second coding sequence comprises a nucleotide sequenceencoding a signal peptide for the agonist of the TrkB receptor, mostpreferably a signal peptide for BDNF. In one preferred embodiment, thenucleotide sequence encodes the canonical signal peptide for BDNF.Preferably, this embodiment of the second coding sequence comprises anucleotide sequence which encodes a signal peptide comprising an aminoacid sequence referred to herein as SEQ ID NO. 20, or a fragment orvariant thereof, as set out below:

[SEQ ID No: 20] MTILFLTMVISYFGCMKA

Preferably, this embodiment of the second coding sequence comprises anucleotide sequence referred to herein as SEQ ID NO. 21, or a fragmentor variant thereof, as set out below:

[SEQ ID No: 21] ATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAA GGCG

The inventors have created a series of extended signal peptides. Inpreferred embodiments, the nucleotide sequence encoding an isoformsignal peptide for BDNF is selected from the group consisting of:isoform 2, 3, 6, 5 and 4. The nucleic acid and amino acid sequences foreach of these extended signal peptides are set out below.

Isoform 2 [SEQ ID No: 22] MFHQVRRVMTILFLTMVISYFGCMKA [SEQ ID No: 23]ATGTTCCACCAGGTGAGAAGAGTGATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCG Isoform 3 and 6 [SEQ ID No: 24]MQSREEEWFHQVRRVMTILFLTMVISYFGCMKA [SEQ ID No: 25]ATGCAGAGCCGGGAAGAGGAATGGTTCCACCAGGTGAGAAGAGTGATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCG Isoform 5 [SEQ ID No:26] MLCAISLCARVRKLRSAGRCGKFHQVRRVMTILFLTMVISYFGCMKA [SEQ ID No: 27]ATGCTCTGTGCGATTTCATTGTGTGCTCGCGTTCGCAAGCTCCGTAGTGCAGGAAGGTGCGGGAAGTTCCACCAGGTGAGAAGAGTGATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCG Isoform 4 [SEQ ID No: 28]MCGATSFLHECTRLILVTTQNAEFLQKGLQVHTCFGVYPHASVWHDCASQKKGCAVYLHVSVEFNKLIPENGFIKFHQVRRVMTILFLTMVISYFGCMKA [SEQ ID No: 29]ATGTGTGGAGCCACCAGTTTTCTCCATGAGTGCACAAGGTTAATCCTTGTTACTACTCAGAATGCTGAGTTTCTACAGAAAGGGTTGCAGGTCCACACATGTTTTGGCGTCTACCCACACGCTTCTGTATGGCATGACTGTGCATCCCAGAAGAAGGGCTGTGCTGTGTACCTCCACGTTTCAGTGGAATTTAACAAACTGATCCCTGAAAATGGTTTCATAAAGTTCCACCAGGTGAGAAGAGTGATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCG

Accordingly, in preferred embodiments, the second coding sequencecomprises a nucleotide sequence encoding a signal sequence peptidereferred to herein as any one of SEQ ID NO. 23, 25, 27 or 29.Preferably, the signal peptide comprises an amino acid sequence referredto herein as any one of SEQ ID NO. 22, 24, 26 or 28.

The inventors have also created various embodiments of novel signalpeptides for the agonist, preferably BDNF. These signal peptidesincrease the level of basicity of the N-terminal section (with addedlysine (K) and arginine (R) residues) and the proceeding hydrophobicregion (with additions of leucine (L) residues), which increasesecretion of BDNF compared to levels observed with the wild-typecanonical signal sequence.

a) QTA003P (IL-2 signal) [SEQ ID No: 30] MYRMQLLSCIALSLALVTNS [SEQ IDNo: 31] ATGTACAGGATGCAACTCCTGTCTTGCATTGCACTAAGTCTTGCACTTGT CACAAACAGT b)QTA004P [SEQ ID No: 32] MKRRVMIILFLTMVISYFGCMK [SEQ ID No: 33]ATGAAAAGAAGAGTGATGATCATCCTTTTCCTTACTATGGTTATTTCATA CTTCGGTTGCATGAAGAGCGc) QTA009P (modified IL-2) [SEQ ID No: 34] MRRMQLLLLIALSLALVTNS [SEQ IDNo: 35] ATGAGGAGGATGCAACTCCTGCTCCTGATTGCACTAAGTCTTGCACTTGT CACAAACAGT d)QTA010P [SEQ ID No: 36] MRRMQLLLLTMVISYFGCMKA [SEQ ID No: 37]ATGAGGAGGATGCAACTCCTGCTCCTGACTATGGTTATTTCATACTTCGG TTGCATGAAGGCG e)QTA0012P [SEQ ID No: 38] MRILLLTMVISYFGCMKA [SEQ ID No: 39]ATGAGAATCCTTCTTCTTACTATGGTTATTTCATACTTCGGTTGCATGAA GGCG f) QTA0013P [SEQID No: 40] MRRILFLTMVISYFGCMKA [SEQ ID No: 41]ATGAGAAGAATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCAT GAAGGCG g) QTA0014P[SEQ ID No: 42] MRRFLFLLVISYFGCMKA [SEQ ID No: 43]ATGAGGAGGTTCCTTTTCCTTCTTGTTATTTCATACTTCGGTTGCATGAA GGCG i) QTA0015P [SEQID No: 44] MRRFLFLLYFGCMKA [SEQ ID No: 45]ATGAGGAGGTTCCTTTTCCTTCTTTACTTCGGTTGCATGAAGGCG

FIG. 6 shows nucleotide and amino acid sequences for further preferredembodiments of signal peptide used in the construct of the invention toboost secretion of the agonist, preferably BDNF. The second residue inthe signal peptide is threonine (T) which is preferably replaced by oneor more basic residue, such as lysine (K) or arginine (R). The nextstretch of residues in the signal peptide including isoleucine (I),leucine (L), phenylalanine (F) and Leucine (L) is preferably replaced byone or more hydrophobic residues.

Accordingly, in preferred embodiments, the second coding sequencecomprises a nucleotide sequence encoding a signal sequence peptidereferred to herein as any one of SEQ ID NO. 31, 33, 35, 37, 39, 41, 43,45, 61, 63, 65, 67, 69, 71, 73, 75, 77, 79, 81, 83, 85, 87, 89, 91, 93,95, 97, 99, lot or 103. Preferably, the signal peptide comprises anamino acid sequence referred to herein as any one of SEQ ID NO. 30, 32,34, 36, 38, 40, 42, 44, 60, 62, 64, 66, 68, 70, 72, 74, 76, 78, 80, 82,84, 86, 88, 90, 92, 94, 96, 98, 100 or 102.

Accordingly, it will be appreciated that the inventors have modified theBDNF gene sequence by removal of the pro-sequence, which also has neverbeen achieved before, with the result of generated properly foldedmature BDNF, combined with the introduction of completely novel signalpeptides, which significantly boost BDNF production and release abovethat ever achieved with the endogenous sequence.

Preferably, the genetic construct comprises left and/or right InvertedTerminal Repeat sequences (ITRs). Preferably, each ITR is disposed atthe 5′ and/or 3′ end of the construct. An ITR can be specific to a virus(e.g. AAV or lentivirus) serotype, and can be any sequence, so long asit forms a hairpin loop in its secondary structure.

The DNA sequence of one embodiment (left ITR from a commerciallyavailable AAV plasmid) of the ITR is represented herein as SEQ ID No:46, as follows:

[SEQ ID NO: 46] CCTGCAGGCAGCTGCGCGCTCGCTCGCTCACTGAGGCCGCCCGGGCGTCGGGCGACCTTTGGTCGCCCGGCCTCAGTGAGCGAGCGAGCGCGCAGAGAGGGAGTGGCCAACTCCATCACTAGGGGTTCCT

The DNA sequence of another embodiment (right ITR from a commerciallyavailable AAV plasmid) of the ITR is represented herein as SEQ ID No:47, as follows:

[SEQ ID NO: 47] AGGAACCCCTAGTGATGGAGTTGGCCACTCCCTCTCTGCGCGCTCGCTCGCTCACTGAGGCCGGGCGACCAAAGGTCGCCCGACGCCCGGGCTTTGCCCGGGCGGCCTCAGTGAGCGAGCGAGCGCGCAGCTGCCTGCAGGFrom the foregoing, the skilled person will appreciate the nucleotidesequence of an embodiment of the construct of the first aspect, as wellas the amino acid sequence of the encoded transgene. However, for theavoidance of doubt, the coding sequence of codon optimised 2940 bpsequence for murine TrkB receptor-viral-2A peptide-mBDNF containedwithin the plasmid QTA020P (and the vector QTA020V), is referred to hereas SEQ ID No: 107, as follows:

[SEQ ID No: 107] ATGAGCCCATGGCTGAAGTGGCACGGACCAGCAATGGCAAGACTGTGGGGCCTGTGCCTGCTGGTGCTGGGCTTCTGGAGAGCCAGCCTGGCCTGTCCAACCTCCTGCAAGTGTAGCTCCGCCAGGATCTGGTGCACAGAGCCTTCTCCAGGCATCGTGGCCTTTCCCCGCCTGGAGCCTAACAGCGTGGATCCCGAGAATATCACCGAGATCCTGATCGCCAACCAGAAGCGGCTGGAGATCATCAATGAGGACGATGTGGAGGCCTACGTGGGCCTGAGAAACCTGACAATCGTGGACTCCGGCCTGAAGTTCGTGGCCTATAAGGCCTTTCTGAAGAACTCTAATCTGAGGCACATCAACTTCACCCGCAATAAGCTGACATCTCTGAGCCGGAGACACTTTCGGCACCTGGATCTGTCCGACCTGATCCTGACCGGCAATCCATTCACATGCTCTTGTGACATCATGTGGCTGAAGACCCTGCAGGAGACAAAGTCTAGCCCCGATACCCAGGACCTGTACTGTCTGAACGAGTCCTCTAAGAATATGCCTCTGGCCAACCTGCAGATCCCTAATTGTGGACTGCCAAGCGCCCGGCTGGCCGCACCTAACCTGACAGTGGAGGAGGGCAAGTCCGTGACACTGTCCTGTTCTGTGGGCGGCGATCCCCTGCCTACCCTGTATTGGGACGTGGGCAACCTGGTGTCTAAGCACATGAATGAGACCTCCCACACACAGGGCTCTCTGAGAATCACAAATATCAGCTCCGACGATAGCGGCAAGCAGATCTCTTGCGTGGCAGAGAACCTGGTGGGAGAGGATCAGGACAGCGTGAATCTGACCGTGCACTTCGCCCCCACCATCACATTTCTGGAGTCTCCTACCAGCGATCACCACTGGTGCATCCCCTTCACAGTGCGGGGAAACCCAAAGCCCGCCCTGCAGTGGTTTTACAACGGCGCCATCCTGAATGAGTCCAAGTATATCTGTACCAAGATCCACGTGACCAACCACACAGAGTACCACGGCTGCCTGCAGCTGGATAATCCCACCCACATGAACAATGGCGACTACACACTGATGGCCAAGAACGAGTATGGCAAGGACGAGAGGCAGATCAGCGCCCACTTCATGGGCCGCCCTGGAGTGGATTATGAGACCAACCCTAATTACCCAGAGGTGCTGTATGAGGACTGGACCACACCTACCGATATCGGCGACACCACAAACAAGTCTAATGAGATCCCAAGCACAGATGTGGCCGACCAGTCTAACAGGGAGCACCTGAGCGTGTACGCAGTGGTGGTCATCGCCTCCGTGGTGGGCTTCTGCCTGCTGGTCATGCTGCTGCTGCTGAAGCTGGCCCGCCACTCTAAGTTTGGCATGAAGGGCCCAGCCTCCGTGATCTCTAATGACGATGACAGCGCCAGCCCCCTGCACCACATCAGCAACGGCTCCAATACCCCTTCTAGCTCCGAGGGCGGCCCAGATGCCGTGATCATCGGCATGACAAAGATCCCCGTGATCGAGAACCCTCAGTACTTCGGCATCACCAATTCCCAGCTGAAGCCTGACACATTTGTGCAGCACATCAAGCGGCACAACATCGTGCTGAAGAGGGAACTGGGAGAGGGAGCCTTCGGCAAGGTGTTTCTGGCCGAGTGCTATAACCTGTGCCCAGAGCAGGATAAGATCCTGGTGGCCGTGAAGACCCTGAAGGATGCCAGCGACAACGCCCGGAAGGACTTCCACAGAGAGGCCGAGCTGCTGACAAATCTGCAGCACGAGCACATCGTGAAGTTTTACGGCGTGTGCGTGGAGGGCGACCCTCTGATCATGGTGTTCGAGTATATGAAGCACGGCGATCTGAACAAGTTTCTGAGAGCACACGGACCAGATGCCGTGCTGATGGCAGAGGGAAATCCCCCTACCGAGCTGACACAGTCTCAGATGCTGCACATTGCACAGCAGATTGCAGCAGGAATGGTGTACCTGGCCAGCCAGCACTTCGTGCACAGGGATCTGGCAACCAGAAACTGCCTGGTGGGAGAGAATCTGCTGGTGAAGATCGGCGACTTTGGCATGTCCCGGGACGTGTACTCTACCGACTACTATAGAGTGGGCGGCCACACAATGCTGCCCATCAGGTGGATGCCACCCGAGAGCATCATGTATCGCAAGTTCACCACAGAGTCTGACGTGTGGAGCCTGGGCGTGGTGCTGTGGGAGATCTTTACCTACGGCAAGCAGCCTTGGTATCAGCTGTCCAACAATGAAGTGATCGAGTGTATTACACAGGGACGCGTGCTGCAGAGGCCACGCACATGCCCCCAGGAGGTGTACGAGCTGATGCTGGGCTGTTGGCAGCGGGAGCCACACACCAGAAAGAACATCAAGAGCATCCACACACTGCTGCAGAATCTGGCCAAGGCCTCCCCCGTGTATCTGGACATCCTGGGCAGCGGAGCTACTAACTTCAGCCTGCTGAAGCAGGCTGGAGACGTGGAGGAGAACCCTGGACCTATGAGAATCCTTCTTCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCGCACTCCGACCCTGCCCGCCGTGGGGAGCTGAGCGTGTGTGACAGTATTAGCGAGTGGGTCACAGCGGCAGATAAAAAGACTGCAGTGGACATGTCTGGCGGGACGGTCACAGTCCTAGAGAAAGTCCCGGTATCCAAAGGCCAACTGAAGCAGTATTTCTACGAGACCAAGTGTAATCCCATGGGTTACACCAAGGAAGGCTGCAGGGGCATAGACAAAAGGCACTGGAACTCGCAATGCCGAACTACCCAATCGTATGTTCGGGCCCTTACTATGGATAGCAAAAAGAGAATTGGCTGGCGATTCATAAGGATAGACACTTCCTGTGTATGTACACTGACCATTAAAAGGGGAAGATAG

The coding sequence of codon optimised 2943 bp sequence for human TrkBreceptor-viral-2A peptide-mBDNF contained within the plasmid QTA029P(and the vector QTA029V), is referred to here as SEQ ID No: 108, asfollows:

[SEQ ID No: 108] ATGTCATCTTGGATCCGCTGGCACGGGCCAGCGATGGCCCGATTGTGGGGCTTCTGCTGGCTTGTTGTAGGCTTCTGGCGCGCGGCGTTCGCGTGTCCGACCTCTTGCAAATGCTCAGCAAGCCGAATTTGGTGCTCAGACCCTAGTCCAGGAATTGTTGCATTCCCCCGACTGGAACCAAACTCCGTCGACCCGGAGAATATAACTGAGATATTTATTGCAAATCAAAAACGCCTTGAAATCATTAACGAGGATGACGTGGAGGCCTACGTTGGTTTGAGAAATCTTACTATTGTCGACTCCGGACTTAAATTTGTAGCTCATAAAGCCTTCCTGAAGAACTCTAATCTGCAGCACATTAATTTCACGAGAAATAAGCTGACCAGCTTGTCCCGGAAGCATTTCCGCCATCTCGACCTGAGCGAGCTCATACTGGTCGGAAACCCATTTACGTGCTCCTGTGACATCATGTGGATCAAAACTCTGCAAGAGGCGAAAAGTAGTCCGGATACCCAAGACCTTTACTGTCTTAATGAAAGCTCAAAAAATATCCCGCTGGCCAACCTGCAGATACCGAACTGCGGACTTCCTAGTGCGAATTTGGCTGCCCCAAATCTTACCGTCGAAGAAGGCAAATCAATCACGCTTTCTTGTTCTGTAGCTGGAGATCCAGTGCCTAATATGTATTGGGACGTGGGTAACCTCGTCTCAAAACATATGAACGAAACGAGCCACACCCAGGGCTCTTTGCGGATAACAAACATCTCCTCTGATGATTCTGGAAAGCAAATCAGTTGCGTAGCTGAAAATCTGGTTGGCGAAGATCAAGATTCAGTCAATCTGACAGTCCATTTCGCCCCAACGATCACCTTTCTGGAGAGCCCAACTAGCGATCACCACTGGTGTATTCCGTTTACGGTAAAAGGAAATCCAAAACCTGCACTCCAATGGTTTTATAATGGAGCCATCTTGAATGAAAGCAAATATATCTGTACTAAAATCCATGTGACGAATCACACCGAGTATCACGGGTGTCTTCAATTGGATAATCCAACCCATATGAATAATGGTGATTATACTTTGATAGCGAAGAACGAATACGGCAAAGACGAAAAGCAAATATCCGCACATTTCATGGGTTGGCCTGGCATCGACGACGGTGCGAACCCGAACTACCCAGATGTTATTTACGAGGATTATGGGACTGCGGCAAACGACATTGGCGACACCACAAACCGAAGCAACGAGATACCAAGTACTGACGTCACTGACAAAACGGGTCGAGAGCATTTGTCTGTTTACGCCGTTGTTGTTATCGCCTCAGTTGTCGGATTTTGCCTGTTGGTCATGCTTTTCCTCCTGAAGCTCGCGCGACATTCCAAGTTTGGCATGAAGGGGCCAGCAAGTGTTATATCCAATGATGATGATAGCGCTTCTCCATTGCACCACATAAGTAACGGCTCAAACACGCCGTCATCTAGTGAAGGTGGACCAGACGCGGTCATTATAGGGATGACTAAAATTCCCGTAATCGAAAACCCTCAGTACTTCGGCATAACCAACAGTCAGCTTAAACCCGATACTTTCGTGCAGCACATCAAAAGGCACAACATAGTCCTCAAGCGCGAACTCGGGGAGGGAGCCTTCGGAAAGGTCTTTCTTGCTGAGTGCTATAATTTGTGTCCTGAGCAGGATAAAATTCTTGTGGCTGTAAAAACTCTCAAAGATGCTTCCGACAACGCACGGAAGGATTTTCATCGGGAGGCCGAACTGTTGACGAATTTGCAGCACGAGCATATAGTAAAGTTCTACGGGGTATGTGTTGAGGGGGACCCGTTGATTATGGTCTTCGAGTATATGAAGCACGGGGACCTGAACAAATTTTTGCGCGCCCATGGGCCTGATGCCGTCCTTATGGCAGAAGGGAACCCTCCAACAGAACTCACCCAGAGTCAGATGTTGCACATAGCGCAACAGATCGCGGCCGGCATGGTTTACCTGGCCAGTCAACACTTCGTGCATAGAGATCTTGCCACTCGCAACTGTTTGGTCGGGGAGAACCTTCTGGTTAAGATTGGTGACTTTGGTATGTCACGAGATGTGTATTCCACTGACTATTACAGAGTTGGGGGTCATACAATGCTTCCTATTCGGTGGATGCCCCCCGAATCCATCATGTACAGAAAGTTCACGACAGAGAGTGATGTTTGGAGTCTCGGCGTGGTGCTCTGGGAAATTTTCACATACGGAAAGCAGCCGTGGTATCAACTTAGCAACAATGAGGTGATAGAGTGTATTACACAGGGTCGGGTGTTGCAGCGCCCTCGAACGTGCCCACAAGAAGTATATGAACTTATGCTCGGGTGCTGGCAAAGAGAACCACATATGAGAAAAAATATCAAGGGGATACATACATTGCTTCAGAACTTGGCCAAGGCATCACCCGTCTACCTCGATATACTGGGCAGCGGAGCTACTAACTTCAGCCTGCTGAAGCAGGCTGGAGACGTGGAGGAGAACCCTGGACCTATGAGAATCCTTCTTCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCGCACTCCGACCCTGCCCGCCGTGGGGAGCTGAGCGTGTGTGACAGTATTAGCGAGTGGGTCACAGCGGCAGATAAAAAGACTGCAGTGGACATGTCTGGCGGGACGGTCACAGTCCTAGAGAAAGTCCCGGTATCCAAAGGCCAACTGAAGCAGTATTTCTACGAGACCAAGTGTAATCCCATGGGTTACACCAAGGAAGGCTGCAGGGGCATAGACAAAAGGCACTGGAACTCGCAATGCCGAACTACCCAATCGTATGTTCGGGCCCTTACTATGGATAGCAAAAAGAGAATTGGCTGGCGATTCATAAGGATAGACACTTCCTGTGTATGTACACTGACCATTAAAAGGGGAAGATAG

Hence, in a most preferred embodiment, the construct comprises anucleotide sequence substantially as set out in SEQ ID No: 107 or 108,or a fragment or variant thereof.

The inventors have created a series of recombinant expression vectorscomprising the construct of the invention.

Thus, according to a second aspect, there is provided a recombinantvector comprising the genetic construct according to the first aspect.

The recombinant vector may be a recombinant AAV (rAAV) vector. The rAAVmay be a naturally occurring vector or a vector with a hybrid AAVserotype. The rAAV may be AAV-1, AAV-2, AAV-3A, AAV-3B, AAV-4, AAV-5,AAV-6, AAV-7, AAV-8, AAV-9, AAV-10, and AAV-11. Preferably, the rAAV isrAAV serotype-2.

Advantageously, recombinant AAV2 evokes a minimal immune response inhost organisms and mediates long-term transgene expression that canpersist in the retina for at least one year after vector administration.

The term “recombinant AAV (rAAV) vector” as used herein means arecombinant AAV-derived nucleic acid containing at least one terminalrepeat sequence.

Preferred embodiments of the vector are shown in FIGS. 2-5.

The constructs and expression vectors described herein can be used totreat optic nerve disorders and a cochlear disorders, and more generallyto promote nerve regeneration and survival.

Hence, according to a third aspect, there is provided the geneticconstruct according to the first aspect, or the recombinant vectoraccording to the second aspect, for use as a medicament or in therapy.

According to a fourth aspect, there is provided the genetic constructaccording to the first aspect, or the recombinant vector according tothe second aspect, for use in treating, preventing or ameliorating anoptic nerve disorder or a cochlear disorder, or for promoting nerveregeneration and/or survival.

According to a fifth aspect, there is provided a method of treating,preventing or ameliorating an optic nerve disorder or a cochleardisorder in a subject, or for promoting nerve regeneration and/orsurvival in a subject, the method comprising administering, to a subjectin need of such treatment, a therapeutically effective amount of thegenetic construct according to the first aspect, or the recombinantvector according to the second aspect.

Preferably, the genetic construct or the recombinant vector according toinvention are used in a gene therapy technique. The agonist encoded bythe construct or vector activate the TrkB also encoded by theconstruct/vector to thereby promote survival of retinal ganglion cells(RGCs) or cochlear cells.

In one embodiment, the optic nerve disorder that is treated may beglaucoma, or any other pathophysiological condition which may result inloss of RGCs, such as trauma to the head or face or vascular insults,for example partial or complete loss in blood supply to the ocularstructures or regions of the brain which receive input from the opticnerve.

In addition, the construct may also be used to support replacement ofRGCs through introduction of untransformed or transformed stem cell intothe eye or regions associated with vision in patients.

In one embodiment, the cochlear disorder which is treated may be hearingloss or deafness. The constructs and vectors of the inventionsignificantly enhance cochlear cell sensitivity to TrkB receptoragonists due to a localised increase in both the TrkB receptor and theagonist of the receptor. The cochlear cells may be hair cells orneuronal spiral ganglion cells which send auditory signals via theiraxons from the ear to the brainstem. The hair cells may be inner earhair cells or outer ear hair cells [42, 43, 44].

In another embodiment, the constructs and vectors may be used to promotenerve regeneration and/or survival.

It will be appreciated that the genetic construct according to the firstaspect, or the recombinant vector according to the second aspect may beused in a medicament, which may be used as a monotherapy (i.e. use ofthe genetic construct according to the first aspect or the vectoraccording to the second aspect of the invention), for treating,ameliorating, or preventing an optic nerve disorder or a cochleardisorder, or for promoting nerve regeneration and/or survival.Alternatively, the genetic construct or the recombinant vector accordingto the invention may be used as an adjunct to, or in combination with,known therapies for treating, ameliorating, or preventing an optic nervedisorder or a cochlear disorder, or for promoting nerve regenerationand/or survival.

The genetic construct according or the recombinant vector according tothe invention may be combined in compositions having a number ofdifferent forms depending, in particular, on the manner in which thecomposition is to be used. Thus, for example, the composition may be inthe form of a powder, tablet, capsule, liquid, ointment, cream, gel,hydrogel, aerosol, spray, micellar solution, transdermal patch, liposomesuspension or any other suitable form that may be administered to aperson or animal in need of treatment. It will be appreciated that thevehicle of medicaments according to the invention should be one which iswell-tolerated by the subject to whom it is given.

The genetic construct or the recombinant vector according to theinvention may also be incorporated within a slow- or delayed-releasedevice. Such devices may, for example, be inserted on or under the skin,and the medicament may be released over weeks or even months. The devicemay be located at least adjacent the treatment site. Such devices may beparticularly advantageous when long-term treatment with the geneticconstruct or the recombinant vector is required and which would normallyrequire frequent administration (e.g. at least daily injection).

In a preferred embodiment, medicaments according to the invention may beadministered to a subject by injection into the blood stream, a nerve ordirectly into a site requiring treatment. For example, the medicamentmay be injected at least adjacent the retina or ear. Injections may beintravenous (bolus or infusion) or subcutaneous (bolus or infusion), orintradermal (bolus or infusion).

It will be appreciated that the amount of the genetic construct or therecombinant vector that is required is determined by its biologicalactivity and bioavailability, which in turn depends on the mode ofadministration, the physiochemical properties of the genetic constructor the recombinant vector and whether it is being used as a monotherapyor in a combined therapy. The frequency of administration will also beinfluenced by the half-life of the cyclic polypeptide within the subjectbeing treated. Optimal dosages to be administered may be determined bythose skilled in the art, and will vary with the particular geneticconstruct or the recombinant vector in use, the strength of thepharmaceutical composition, the mode of administration, and theadvancement of the optic nerve disorder or the cochlear disorder.Additional factors depending on the particular subject being treatedwill result in a need to adjust dosages, including subject age, weight,gender, diet, and time of administration.

Generally, a daily dose of between 0.001 μg/kg of body weight and 10mg/kg of body weight, or between 0.01 μg/kg of body weight and 1 mg/kgof body weight, of the cyclic polypeptide according to the invention maybe used for treating, ameliorating, or preventing an optic nervedisorder or a cochlear disorder, depending upon the genetic construct orrecombinant vector used.

The genetic construct or the recombinant vector may be administeredbefore, during or after onset of the optic nerve or cochlear disorder.Daily doses may be given as a single administration (e.g. a single dailyinjection or inhalation of a nasal spray).

Alternatively, the genetic construct or the recombinant vector mayrequire administration twice or more times during a day. As an example,the genetic construct or the recombinant vector may be administered astwo (or more depending upon the severity of the optic nerve or cochleardisorder being treated) daily doses of between 0.07 μg and 700 mg (i.e.assuming a body weight of 70 kg). A patient receiving treatment may takea first dose upon waking and then a second dose in the evening (if on atwo dose regime) or at 3- or 4-hourly intervals thereafter.Alternatively, a slow release device may be used to provide optimaldoses of the genetic construct or the recombinant vector according tothe invention to a patient without the need to administer repeateddoses.

Known procedures, such as those conventionally employed by thepharmaceutical industry (e.g. in vivo experimentation, clinical trials,etc.), may be used to form specific formulations of the geneticconstruct or the recombinant vector according to the invention andprecise therapeutic regimes (such as daily doses of the agents and thefrequency of administration). The inventors believe that they are thefirst to suggest a genetic construct encoding promoter operably linkedto coding sequences of a TrkB receptor and a TrkB receptor agonist.

According to a sixth aspect, there is provided a pharmaceuticalcomposition comprising the genetic construct according to the firstaspect, or the recombinant vector according to the second aspect, and apharmaceutically acceptable vehicle.

According to a seventh aspect, there is provided a method of preparingthe pharmaceutical composition according to the sixth aspect, the methodcomprising contacting the genetic construct according to the firstaspect, or the recombinant vector according to the second aspect, with apharmaceutically acceptable vehicle.

A “subject” may be a vertebrate, mammal, or domestic animal. Hence,compositions and medicaments according to the invention may be used totreat any mammal, for example livestock (e.g. a horse), pets, or may beused in other veterinary applications. Most preferably, however, thesubject is a human being.

A “therapeutically effective amount” of the genetic construct, therecombinant vector or the pharmaceutical composition is any amountwhich, when administered to a subject, is the amount of theaforementioned that is needed to treat glaucoma, deafness or produce thedesired effect, such as promoting nerve regeneration and/or survival.

For example, the therapeutically effective amount of the geneticconstruct, the recombinant vector or the pharmaceutical composition usedmay be from about 0.01 mg to about 800 mg, and preferably from about0.01 mg to about 500 mg. It is preferred that the amount of the geneticconstruct, the recombinant vector or the pharmaceutical composition isan amount from about 0.1 mg to about 250 mg, and most preferably fromabout 0.1 mg to about 20 mg.

A “pharmaceutically acceptable vehicle” as referred to herein, is anyknown compound or combination of known compounds that are known to thoseskilled in the art to be useful in formulating pharmaceuticalcompositions.

In one embodiment, the pharmaceutically acceptable vehicle may be asolid, and the composition may be in the form of a powder or tablet. Asolid pharmaceutically acceptable vehicle may include one or moresubstances which may also act as flavouring agents, lubricants,solubilisers, suspending agents, dyes, fillers, glidants, compressionaids, inert binders, sweeteners, preservatives, dyes, coatings, ortablet-disintegrating agents. The vehicle may also be an encapsulatingmaterial. In powders, the vehicle is a finely divided solid that is inadmixture with the finely divided active agents according to theinvention. In tablets, the active agent (e.g. the genetic construct orrecombinant vector according to the invention) may be mixed with avehicle having the necessary compression properties in suitableproportions and compacted in the shape and size desired. The powders andtablets preferably contain up to 99% of the active agents. Suitablesolid vehicles include, for example calcium phosphate, magnesiumstearate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose,polyvinylpyrrolidine, low melting waxes and ion exchange resins. Inanother embodiment, the pharmaceutical vehicle may be a gel and thecomposition may be in the form of a cream or the like.

However, the pharmaceutical vehicle may be a liquid, and thepharmaceutical composition is in the form of a solution. Liquid vehiclesare used in preparing solutions, suspensions, emulsions, syrups, elixirsand pressurized compositions. The genetic construct or the recombinantvector according to the invention may be dissolved or suspended in apharmaceutically acceptable liquid vehicle such as water, an organicsolvent, a mixture of both or pharmaceutically acceptable oils or fats.The liquid vehicle can contain other suitable pharmaceutical additivessuch as solubilisers, emulsifiers, buffers, preservatives, sweeteners,flavouring agents, suspending agents, thickening agents, colours,viscosity regulators, stabilizers or osmo-regulators. Suitable examplesof liquid vehicles for oral and parenteral administration include water(partially containing additives as above, e.g. cellulose derivatives,preferably sodium carboxymethyl cellulose solution), alcohols (includingmonohydric alcohols and polyhydric alcohols, e.g. glycols) and theirderivatives, and oils (e.g. fractionated coconut oil and arachis oil).For parenteral administration, the vehicle can also be an oily estersuch as ethyl oleate and isopropyl myristate. Sterile liquid vehiclesare useful in sterile liquid form compositions for parenteraladministration. The liquid vehicle for pressurized compositions can be ahalogenated hydrocarbon or other pharmaceutically acceptable propellant.

Liquid pharmaceutical compositions, which are sterile solutions orsuspensions, can be utilized by, for example, intramuscular,intrathecal, epidural, intraperitoneal, intravenous and particularlysubcutaneous injection. The genetic construct or the recombinant vectormay be prepared as a sterile solid composition that may be dissolved orsuspended at the time of administration using sterile water, saline, orother appropriate sterile injectable medium.

The genetic construct, the recombinant vector and the pharmaceuticalcomposition of the invention may be administered orally in the form of asterile solution or suspension containing other solutes or suspendingagents (for example, enough saline or glucose to make the solutionisotonic), bile salts, acacia, gelatin, sorbitan monoleate, polysorbate80 (oleate esters of sorbitol and its anhydrides copolymerized withethylene oxide) and the like. The genetic construct, the recombinantvector or the pharmaceutical composition according to the invention canalso be administered orally either in liquid or solid composition form.Compositions suitable for oral administration include solid forms, suchas pills, capsules, granules, tablets, and powders, and liquid forms,such as solutions, syrups, elixirs, and suspensions. Forms useful forparenteral administration include sterile solutions, emulsions, andsuspensions.

It will be appreciated that the invention extends to any nucleic acid orpeptide or variant, derivative or analogue thereof, which comprisessubstantially the amino acid or nucleic acid sequences of any of thesequences referred to herein, including variants or fragments thereof.The terms “substantially the amino acid/nucleotide/peptide sequence”,“variant” and “fragment”, can be a sequence that has at least 40%sequence identity with the amino acid/nucleotide/peptide sequences ofany one of the sequences referred to herein, for example 40% identitywith the sequence identified as SEQ ID No:1-108, and so on.

Amino acid/polynucleotide/polypeptide sequences with a sequence identitywhich is greater than 65%, more preferably greater than 70%, even morepreferably greater than 75%, and still more preferably greater than 80%sequence identity to any of the sequences referred to are alsoenvisaged. Preferably, the amino acid/polynucleotide/polypeptidesequence has at least 85% identity with any of the sequences referredto, more preferably at least 90% identity, even more preferably at least92% identity, even more preferably at least 95% identity, even morepreferably at least 97% identity, even more preferably at least 98%identity and, most preferably at least 99% identity with any of thesequences referred to herein.

The skilled technician will appreciate how to calculate the percentageidentity between two amino acid/polynucleotide/polypeptide sequences. Inorder to calculate the percentage identity between two aminoacid/polynucleotide/polypeptide sequences, an alignment of the twosequences must first be prepared, followed by calculation of thesequence identity value. The percentage identity for two sequences maytake different values depending on:—(i) the method used to align thesequences, for example, ClustalW, BLAST, FASTA, Smith-Waterman(implemented in different programs), or structural alignment from 3Dcomparison; and (ii) the parameters used by the alignment method, forexample, local vs global alignment, the pair-score matrix used (e.g.BLOSUM62, PAM250, Gonnet etc.), and gap-penalty, e.g. functional formand constants.

Having made the alignment, there are many different ways of calculatingpercentage identity between the two sequences. For example, one maydivide the number of identities by: (i) the length of shortest sequence;(ii) the length of alignment; (iii) the mean length of sequence; (iv)the number of non-gap positions; or (iv) the number of equivalencedpositions excluding overhangs. Furthermore, it will be appreciated thatpercentage identity is also strongly length dependent. Therefore, theshorter a pair of sequences is, the higher the sequence identity one mayexpect to occur by chance.

Hence, it will be appreciated that the accurate alignment of protein orDNA sequences is a complex process. The popular multiple alignmentprogram ClustalW (Thompson et al., 1994, Nucleic Acids Research, 22,4673-4680; Thompson et al., 1997, Nucleic Acids Research, 24, 4876-4882)is a preferred way for generating multiple alignments of proteins or DNAin accordance with the invention. Suitable parameters for ClustalW maybe as follows: For DNA alignments: Gap Open Penalty=15.0, Gap ExtensionPenalty=6.66, and Matrix=Identity. For protein alignments: Gap OpenPenalty=10.0, Gap Extension Penalty=0.2, and Matrix=Gonnet. For DNA andProtein alignments: ENDGAP=−1, and GAPDIST=4. Those skilled in the artwill be aware that it may be necessary to vary these and otherparameters for optimal sequence alignment.

Preferably, calculation of percentage identities between two aminoacid/polynucleotide/polypeptide sequences may then be calculated fromsuch an alignment as (N/T)*100, where N is the number of positions atwhich the sequences share an identical residue, and T is the totalnumber of positions compared including gaps but excluding overhangs.Hence, a most preferred method for calculating percentage identitybetween two sequences comprises (i) preparing a sequence alignment usingthe ClustalW program using a suitable set of parameters, for example, asset out above; and (ii) inserting the values of N and T into thefollowing formula:—Sequence Identity=(N/T)*100.

Alternative methods for identifying similar sequences will be known tothose skilled in the art. For example, a substantially similarnucleotide sequence will be encoded by a sequence which hybridizes toDNA sequences or their complements under stringent conditions. Bystringent conditions, we mean the nucleotide hybridises to filter-boundDNA or RNA in 3× sodium chloride/sodium citrate (SSC) at approximately45° C. followed by at least one wash in 0.2×SSC/0.1% SDS atapproximately 20-65° C. Alternatively, a substantially similarpolypeptide may differ by at least 1, but less than 5, 10, 20, 50 or 100amino acids from the sequences shown in, for example, SEQ ID Nos: 3 and5.

Due to the degeneracy of the genetic code, it is clear that any nucleicacid sequence described herein could be varied or changed withoutsubstantially affecting the sequence of the protein encoded thereby, toprovide a functional variant thereof. Suitable nucleotide variants arethose having a sequence altered by the substitution of different codonsthat encode the same amino acid within the sequence, thus producing asilent change. Other suitable variants are those having homologousnucleotide sequences but comprising all, or portions of, sequence, whichare altered by the substitution of different codons that encode an aminoacid with a side chain of similar biophysical properties to the aminoacid it substitutes, to produce a conservative change. For example smallnon-polar, hydrophobic amino acids include glycine, alanine, leucine,isoleucine, valine, proline, and methionine. Large non-polar,hydrophobic amino acids include phenylalanine, tryptophan and tyrosine.The polar neutral amino acids include serine, threonine, cysteine,asparagine and glutamine. The positively charged (basic) amino acidsinclude lysine, arginine and histidine. The negatively charged (acidic)amino acids include aspartic acid and glutamic acid. It will thereforebe appreciated which amino acids may be replaced with an amino acidhaving similar biophysical properties, and the skilled technician willknow the nucleotide sequences encoding these amino acids.

According to another aspect, there is provided a genetic constructcomprising a promoter operably linked to a first coding sequence, whichencodes the tyrosine kinase receptor B (TrkB), and a second codingsequence, which encodes an agonist of the TrkB receptor for activatingTrkB to thereby promote survival of retinal ganglion cells (RGCs), nervecells or cochlear cells.

All of the features described herein (including any accompanying claims,abstract and drawings), and/or all of the steps of any method or processso disclosed, may be combined with any of the above aspects in anycombination, except combinations where at least some of such featuresand/or steps are mutually exclusive.

For a better understanding of the invention, and to show how embodimentsof the same may be carried into effect, reference will now be made, byway of example, to the accompanying Figure, in which:—

FIG. 1 is schematic of one embodiment of a genetic construct accordingto the invention;

FIG. 2 is a schematic drawing of a first embodiment of a recombinantvector according to the invention known as “Plasmid QTA001PA” containingcanonical signal sequence (blue) plus proBDNF (red) and mBDNF (black).It also includes an -IRES-GFP- sequence (cyan and purple);

FIG. 3 is a schematic drawing of a second embodiment of the recombinantvector according to the invention known as “Plasmid QTA002P” with noproBDNF (but produces only mBDNF) and same signal sequence (blue) asQTA001PA. It also includes an -IRES-GFP- sequence (cyan and purple);

FIG. 4 is a schematic drawing of a third embodiment of the recombinantvector according to the invention known as of “Plasmid QTA003P” with noproBDNF (but produces only mBDNF) and IL-2 signal sequence (blue). Italso includes an -IRES-GFP- sequence (cyan and purple);

FIG. 5 is a schematic drawing of a fourth embodiment of a recombinantvector according to the invention known as “Plasmid QTA004P” with noproBDNF (but produces only mBDNF) and a novel signal sequence (blue). Italso includes an -IRES-GFP- sequence (cyan and purple);

FIG. 6 shows nucleotide and amino acid sequences for differentembodiments of signal peptide used in the construct of the invention.The second residue is threonine (t) which can be replaced by one or morebasic residue, such as lysine (K) or arginine (R). The next stretch ofresidues including isoleucine (I), leucine (L), phenylalanine (F) andLeucine (L) can be replaced by one or more hydrophobic residues;

FIG. 7 shows release of BDNF from HEK293 cells using a specific ELISA at24 hours following transduction of a plasmid (4 μg DNA/well) containinggenes coding for mBDNF with differing signal peptide sequences andwithout the coding sequence for the extended proBDNF component (Datashown as mean±SEM for n=4);

FIG. 8 shows Western blotting results of cellular concentrations ofBDNF-immunoreactive material (arbitrary units) in HEK293 cell lysates 24hours after plasmid transduction (Data shown as mean±SEM for n=4);

FIG. 9 shows BDNF-immunoreactivity in Western blots of cell lysatesshowing two molecular weight bands (32 kDa and 14 kDa) when cells weretransduced with QTA001PA, versus only a single 14 kDa band with QTA002P,QTA003P and QTA004P transduction;

FIG. 10 shows proBDNF concentrations in the HEK293 incubation medium asmeasured using a specific ELISA 24 hours after plasmid transductionusing a selective proBDNF ELISA (Data shown as mean±SEM for n=4);

FIG. 11 shows BDNF expression in HEK293 cell lysate by plasmids QTA002P(endogenous canonical signal peptide sequence), and QTA009P to QTA013P.Data is shown as mean+S.E.M. *** P<0.01 as compared to QTA002P;

FIG. 12 shows BDNF expression in HEK293 cell incubation medium byplasmids QTA002P (endogenous canonical signal peptide sequence), andQTA009P to QTA013P. Data is shown as mean+S.E.M. *** P<0.01 as comparedto QTA002P;

FIG. 13 shows Western Blots from HEK293 cells 24 hours after they weretransduced with plasmids QTA015P (expressing BDNF and eGFP separated byan IRES spacer), QTA021P (expressing BDNF followed by eGFP separated bya functional viral-2A peptide sequence), QTA022P (expressing BDNFfollowed by eGFP separated by a non-functional viral-2A peptidesequence) and QTA023P (expressing eGFP followed by coding for BDNFseparated by a functional viral-2A peptide sequence). Data shown asBDNF-immunoreactivity (A), eGFP-immunoreactivity (B) and the amount ofBDNF released from the HEK293 cells into the incubation medium (C). Datais shown as mean+S.E.M of the density in the bands;

FIG. 14A shows Western blot of HEK293 cell homogenates 48 hours aftertransfection with the QTA020V vector and showing efficient processing ofthe large precursor coding region which includes the TrkB receptor andBDNF separated by the viral-2A peptide sequence. FIGS. 14B and 14C showthat the transgene proteins produced after vial-2A peptide cleavage havebeen transported to the correct intracellular compartments in HEK293cells after processing (TrkB receptors to the cell surface and BDNF tostorage vesicles prior to release);

FIG. 15A shows TrkB receptor expression and FIG. 15B shows BDNFexpression in mouse retinal homogenate for the rAAV2 vector, QTA020V.Data is shown as mean+S.E.M of the density in the Western blot of mouseretina homogenates. ** P<0.01 as compared to naïve (un-injectedanimals);

FIG. 16 shows expression of TrkB (A) and BDNF (B) transgenes in mouseretinal ganglion cell layer as shown by immunocytochemistry followinginjection of QTA020V, a rAAV2 vector containing the coding for the TrkBreceptor and BDNF, separated by the viral-2A peptide sequence; and

FIG. 17 shows retinal ganglion cell (RGC) survival following optic nervecrush (ONC) in the mouse versus control animals treated withrAAV2-CAG-eGFP vector. Data shown as mean+S.E.M. for average numbers ofretinal ganglion cells throughout the retina per animal as counted byBrn3A-positive cells in retinal flat-mounts. ***P<0.001, *P<0.05 ascompared to controls.

EXAMPLES

Methods and Materials

Molecular Cloning and Plasmid Constructs

Codon optimisation of DNA sequences was performed using the on-line tool(http://www.idtdna.com/CodonOpt) and DNA blocks were synthesised byIntegrated DNA technologies, Inc. (IDT; 9180 N. McCormick Boulevard,Skokie, Ill. 60076-2920, USA) or GenScript (860 Centennial Ave,Piscataway, N.J. 08854, USA). Cloning to make the master plasmidQTA001PA and subsequent plasmids were performed using standard molecularbiology and cloning techniques.

Plasmid Scale Up and Purification

DNA Plasmids were scaled up in SURE competent cells (AgilentTechnologies; cat. #200238) overnight to provide 2.29 μg/μl plasmidfollowing maxi-prep purification. The remaining plasmids were scaled upto 500 μg scale and transduction quality with minimal endotoxinpresence.

HEK293 Culture and Cell Transduction with Plasmid DNA

HEK293 cells (400,000 cells) were cultured in poly-L-lysine (10 ug/mL,Sigma-Aldrich; cat. # P1274) coated 6 well plates in 1.5 mL Dulbecco'sminimum essential medium (DMEM) containing 10% foetal bovine serum(FBS), 1% penicillin and 1% streptomycin (1% Pen/Strep) until 80%confluent. The medium was then exchanged for 2 mL DMEM (no additives).Two to three hours later, an additional 0.5 ml transfection mediumcontaining 4 μg plasmid DNA plus 10 μL lipofectamine (4 μL/mL; ThermoFisher Scientific; cat. #12566014) was added to each well resulting inan overall volume of 2.5 ml throughout the transfection period and forsupernatant collection.

BDNF Measurement by ELISA

The amount of BDNF secreted from HEK293 cells was measured in cellculture medium 24 hours after transfection. Medium was centrifuged, toremove debris, and measured using a commercial Human BDNF ELISA kit(Sigma-Aldrich, product # RAB0026). BDNF concentration was determined bycomparing samples to freshly made BDNF standards.

Western Blotting for BDNF and TrkB Receptors

The amount of BDNF and TrkB-immunoreactivity within the HEK293 cells wasmeasured by removing the DMEM incubation medium, washing the cells incold phosphate buffered saline and the addition of 350 μL freshlyprepared lysis buffer to the wells (10 ml Lysis-M reagent+1 tablet ofcomplete Mini Protease Inhibitor Cocktail, Roche; cat. #04719964001,+100 μl Halt phosphatase inhibitor cocktail (100×), Thermo Scientific;cat. #78428). After cell homogenisation, the protein suspension wasquantified using the BCA assay (Pierce BCA protein assay kit, ThermoScientific; cat. #23227). Between 6 μg and 15 μg HEK293 cell lysateprotein/lane were run down a Bis-Tris gel (12% NuPAGE Novex; cat. #NP0342BOX, Thermo Scientific) and examined by Western blotting using theprimary rabbit polyclonal anti-BDNF antibodies (Santa Cruz BiotechnologyInc; product # sc-546; at 1:500 dilution), rabbit polyclonal anti-TrkBantibodies (Abcam; cat. # ab33655, used at 1:2000 dilution) or eGFPantibodies (Abcam product # ab-290 used at 1:500) which were incubatedovernight. Primary antibodies were visualised with HRP conjugatedanti-rabbit antibodies (Vector Laboratories; cat. # PI-1000, at 1:8000)and signal detection using ECL Prime (Amersham, GE Healthcare, UK) andan Alliance Western blot imaging system (UVItec Ltd, Cambridge, UK). ForWestern blots of mouse retina, eyes from vector-treated animals werehomogenized in 500 μL freshly prepared lysis buffer (10 ml Lysis-Mreagent+1 tablet of cOmplete Mini Protease Inhibitor Cocktail, Rocheproduct #04719964001+100 μl Halt phosphatase inhibitor cocktail (100×),Thermo Scientific product #78428). Tissue was disrupted for 1 minute(Qiagen, TissueRuptor product #9001273) and then kept on ice for anadditional 15 minutes. The protein was then analysed by Western blottingas described above.

Immunocytochemistry

HEK293 cells (70,000) were seeded on 13 mm, poly-L-lysine coatedcoverslips within 4 well plates and incubated in DMEM containing 10% FBSand 1% Pen/Strep in 0.5 ml medium. Once the cells had grown to 80%confluence, the medium was exchanged for 0.4 ml DMEM (no additives) for2-3 hours then an additional 0.1 mL transfection medium (0.8 μg plasmidDNA+2 μl lipofectamine) was added so that the final volume reached 0.5ml. Coverslips were washed twice in PBS and fixed for 30 min in 4%paraformaldehyde in 1M phosphate buffered saline (PBS) at roomtemperature. After three more washes in PBS, cells were blocked andpermeabilized by incubation in 5% normal goat serum (NGS), 3% bovineserum albumin (BSA) and 0.3% Triton X-100 in PBS for 60 minutes at roomtemperature. Cells were then incubated overnight at 4° C. withcommercial rabbit polyclonal antibodies for BDNF (Santa CruzBiotechnology Inc; product # sc-546; at 1:300 dilution) or TrkB (Abcamproduct # ab33655, diluted 1:500) diluted in blocking solution. Stainingwas revealed using secondary anti-rabbit antibodies conjugated to alexafluor 647 (Invitrogen, product # A21248 at 1:1000) for 2 hours at roomtemperature. Cell nuclei were also counterstained with 1 μg/ml DAPI(Thermo Scientific, product # D1306 at 1:8000). Cells were furtherwashed three times before being mounted with FluorSave™ reagent(Calbiochem/EMD Chemicals Inc., Gibbstown, N.J., USA) prior to imaging.Imaging was carried out using a 20× objective and a Leica DM6000epifluorescence microscope (Leica Microsystems, Wetzlar, Germany) or aLeica SP5 confocal microscope (Leica Microsystems, Wetzlar, Germany)equipped with a 63× oil objective using a 3× digital zoom and 0.5-0.8sequential scanning z-step interval.

For immunocytochemistry of retinal structures from control or vectortreated animals, carefully dissected eyes were fixed in 4%paraformaldehyde/0.1% PBS (pH 7.4) overnight and dehydrated in 30%sucrose/0.1% PBS at 4° C. (24 hours). Eyes were then embedded in siliconmoulds containing optimal cutting temperature compound (OCT) (SakuraFinetek, Zoeterwoude, Netherlands) and frozen on dry ice. 13 μm sectionsthrough the dorsal-ventral/superior-inferior axis of the retina werecollected onto superfrost plus slides (VWR product #631-0108), using aBright OTF 5000 cryostat (Bright Instruments, Huntingdon, UK). Slideswere washed three times in PBS, and permeabilized in 5% normal goatserum (NGS), 3% bovine serum albumin (BSA) and 0.3% Triton X-100 in PBSfor 60 minutes at room temperature. Slides were then incubated overnightat 4° C. with commercial rabbit polyclonal antibodies for BDNF (SantaCruz Biotechnology Inc product # sc-546 1:300) or TrkB (Abcam product #ab33655 1:500), diluted in blocking solution. Staining was revealedusing secondary anti-rabbit antibodies conjugated to alexa fluor 647(Invitrogen, product # A21248 at 1:1000) for 2 hours at roomtemperature. Retinal cell nuclei were also counterstained with 1 μg/mLDAPI (Thermo Scientific, product # D1306 at 1:8000). Slides were furtherwashed three times before being mounted with FluorSave™ reagent(Calbiochem/EMD Chemicals Inc., Gibbstown, N.J., USA) prior to imaging.Imaging was carried out using a 20× objective and a Leica DM6000epifluorescence microscope (Leica Microsystems, Wetzlar, Germany) or aLeica SP5 confocal microscope (Leica Microsystems, Wetzlar, Germany)equipped with a 63× oil objective using a 3× digital zoom and 0.5-0.8sequential scanning z-step interval.

Intravitreal Injections

Following a 7-10 day acclimatisation period, mice were randomised intovarious study groups. They were then anaesthetized with intraperitonealinjection of ketamine (50 mg/kg) and xylazine (5 g/kg). Topical 1%tetracaine eye drops were administered on Day 1 of the study. Pupillarydilation was achieved using 1% tropicamide eye drops. Using an operatingmicroscope, a partial-thickness scleral pilot hole was made with a30-gauge needle to facilitate penetration of the underlying sclera,choroid, and retina by a fine metal micropipette with a tip diameter of30 μm and a tip length of 2.5 mm. The micropipette was then connected toa 10 μl glass syringe (Hamilton Co., Reno, Nev.) prior drawing up 2 μlof vector suspensions into the pipette depending on the group. Care wastaken to avoid penetration of the lens or damage to the vortex veinsduring intravitreal injection. The injection site was aimedapproximately 3 mm posterior to the supero-temporal limbus. Injectionswere given slowly over 1 minute to allow diffusion of vector suspension.The right eye was left untouched and served as an internal contralateralcontrol.

Optic Nerve Crush (ONC)

Three weeks (21 days) after vector administration, the mice were subjectto the ONC procedure, left untreated or sham-crushed. Under a binocularoperating scope, a small incision was made with spring scissors in theconjunctiva beginning inferior to the globe and around the eyetemporally. This exposed the posterior aspect of the globe, allowingvisualization of the optic nerve. The exposed optic nerve was graspedapproximately 1-3 mm from the globe with cross-action forceps (Dumont #N7 cat. # RS-5027; Roboz) for 10 s, with the only pressure from theself-clamping action to press on the nerve. After 10 s the optic nervewas released, the forceps are removed and the eye rotates back intoplace. 7 days after ONC, animals were culled. Both eyes from each groupwere fixed by placing the organ in 4% paraformaldehyde/0.1% PBS (pH 7.4)overnight. Retinal flat-mounts were then prepared following dissectionof the posterior eye structure from the cornea and removal of the lens.The retinal flat-mounts were post fixed for 30 minutes in 4%paraformaldehyde/0.1% PBS and washed in 0.5% Triton X-100 in PBS.Retinas were frozen at −80° C. for 10 minutes to permeate the nuclearmembrane and improve antibody permeation before blocking in 10% normaldonkey serum (NDS), 2% bovine serum albumin (BSA) and 2% Triton X-100 inPBS for 60 minutes at room temperature. RGCs were counterstained withantibodies against Brn3A (1:200 Santa Cruz, # sc-31984) and visualisedunder fluorescence microscopy using a 20× objective and a Leica DM6000epifluorescence microscope (Leica Microsystems, Wetzlar, Germany).Higher resolution images were be obtained using a Leica SP5 confocalmicroscope (Leica Microsystems) equipped with a 40× oil objective usinga 1.5× digital zoom and 0.5-0.8 sequential scanning z-step interval. RGCcell counts were measured by ImageJ using the image-based tool forcounting nuclei plugin (ITCN) and expressed as density of RGCs/mm².

Constructs and Vectors

The inventors have generated a genetic construct, as shown in FIG. 1,which may be used to treat a subject afflicted with an optic nervepathology, such as glaucoma, or a cochlear pathology, or for promotingnerve regeneration and/or survival. The construct has been designed tomaintain or increase the density of TrkB receptors on the cell surfaceof RGCs and maintain or increase signaling through the TrkB receptorpathway by concomitant production and local release of mBDNF.

The construct comprises transgenes encoding the TrkB receptor and itsagonist, mature brain-derived neurotrophic factor. These transgenes areoperably-linked to a single promoter, which is either the human synapsinI (SYN I) promoter or the CAG promoter. Advantageously, the construct ofFIG. 1 can be placed in a rAAV2 vector without being hindered by thesize of the transgenes that it encodes. This is because the construct isorientated such that the first transgene, TrkB, is linked to the viral2A peptide sequence followed by the BDNF signal peptide and then themature protein. This orientation also minimises immunogenicity risksbecause the short N-terminal amino acid sequence of the viral 2A peptideremains attached to the intracellular portion of the TrkB receptor andthe residual proline amino acid from the C-terminal viral 2A sequenceremains attached to the N-terminal BDNF signal peptide and is ultimatelyremoved from the mBDNF protein following cleavage. The vector may beplaced in a pharmacologically acceptable buffered solution, which may beadministered to a subject.

FIGS. 2-5 show various embodiments of expression vectors. FIG. 2 showsthe vector known as “Plasmid QTA001PA” containing canonical signalsequence (blue) (i.e. MTILFLTMVISYFGCMKA [SEQ ID NO:20]) plus proBDNF(red) and mBDNF (black). FIG. 3 shows the vector known as “PlasmidQTA002P”. It does not encode proBDNF but produces only mBDNF, andencodes the same signal sequence (blue) as QTA001PA. FIG. 4 shows thevector known as “Plasmid QTA003P” which also does not encode proBDNF butproduces only mBDNF. Instead of the canonical signal sequence for mBDNF,it comprises an IL-2 signal sequence (blue). Finally, FIG. 5 shows thevector known as “Plasmid QTA004P”. It does not encode proBDNF butinstead produces only mBDNF. It also encodes a novel signal sequence(blue), [SEQ ID NO: 32].

The inventors have produced and investigated the construct and vectorrelating to the glaucoma gene therapy concept starting with the matureBDNF (mBDNF) element. They have clearly demonstrated production andrelease of mBDNF from HEK293 cells following lipofectamine transductionwith a plasmid which contains the BDNF sequence without the proBDNFcoding region (QTA002P, see FIG. 3) (see FIG. 7). The mBDNF releasedfrom the cells is the predicted 14 kDa monomer (measured using Westernblotting and a commercially available antibody for BDNF) and there is noevidence for protein aggregates, as has been reported by several groupsattempting to generate commercial amounts of mBDNF using yeast and othercell-based manufacturing approaches¹. The mBDNF is therefore released ina form which can allow the protein molecules to form non-covalent dimersin order to activate TrkB receptors.

Using an ELISA for BDNF (which does not differentiate between mBDNF andthe larger extended proBDNF protein), the inventors have alsodemonstrated that it is possible to substitute the DNA sequence codingfor the endogenous canonical 18-amino acid signal peptide sequence(MTILFLTMVISYFGCMKA) with a novel peptide sequence (QTA004P—see FIG. 5)and release equivalent levels of BDNF into the HEK293 incubation mediumfollowing lipofectamine transduction of the cells with plasmidscontaining the BDNF gene (see FIG. 7).

Substitution of the endogenous signal peptide with the sequence codingfor the interleukin-2 signal peptide (QTA003P—see FIG. 4) was lesseffective in releasing BDNF from the medium. Levels of BDNF releasedinto the medium are currently around 1-2 nM and concentrations of thisagonist are sufficient to maximally activate the specific TrkB receptors(IC50 of around 0.9 nM). Levels of BDNF release are approximately35-fold higher (876±87 ng/mL BDNF) with the plasmid QTA001PA (see FIG.2) which contains the combined proBDNF and mBDNF sequences and whichalso includes the 18-amino acid canonical signal peptide as compared tothe plasmids QTA002P (see FIG. 3) and QTA004P (see FIG. 5).

Measurements of BDNF remaining in the cell by quantitative Westernblotting 24 hours after lipofectamine plasmid transduction revealedlower BDNF remaining concentrations with QTA001PA than those withQTA002P and QTA004P (see FIG. 8).

Moreover, around half of the BDNF immunoreactivity in the cell lysatestransduced by QTA001PA was in the form of the proBDNF (molecular weightband at 32 kDa) whereas the proBDNF band was absent in the lysates ofcells transduced with QTA002P, QTA003P and QTA004P (see FIG. 9),probably because these plasmids do not contain a proBDNF extended codingsequence.

Using an ELISA specific for the proBDNF, the inventors were able todemonstrate that around 70 ng/mL (2.2 nM or 3.5%) of releasedBDNF-immunoreactivity from cells transduced by QTA001PA is in the formof proBDNF whilst the majority (96.5% or 876 ng/mL/63 nM) is released asmBDNF (see FIG. 10). There was no proBDNF-immunoreactivity detected fromcells transduced by QTA002P, QTA003P or QTA004P which do not contain thecoding sequence for the extended proBDNF.

Accordingly, it is clear that all of the plasmids are capable ofproducing the 14 kDa mBDNF protein, but that the amounts of mBDNFreleased from the HEK293 cells are largely dependent on efficiency inprotein storage and packaging into secretory vesicles. The extended formof the protein, containing the combined proBDNF and mBDNF sequences, asproduced with plasmid QTA001PA (FIG. 2) is therefore packaged intosecretory vesicles and released into the incubation medium much moreefficiently than with the smaller mBDNF sequences which appear toaccumulate within the cell.

Referring to FIG. 11, it shows that substitution of the coding for theendogenous canonical signal peptide sequence, as represented in plasmidQTA002P, with novel sequences included in plasmids QTA009P to QTA013Pincreases the concentration of BDNF in HEK293 cells 24 hours aftertransduction with plasmids. FIG. 12 demonstrates that substitution ofthe endogenous canonical signal peptide coding sequence included inplasmid QTA002P with novel sequences (plasmids QTA009P to QTA013P)increases release of BDNF (as measured by ELISA) from HEK293 cells, asmeasured 24 hours after transduction with plasmids.

As shown in FIG. 13, the addition of the viral-2A peptide sequenceresults in efficient processing of the coding sequence for the largeprecursor protein into two transgenes, eGFP and BDNF. The Western blotsshow HEK293 cells 24 hours after they were transduced with plasmids: (i)QTA015P (expressing BDNF and eGFP separated by an IRES spacer), (ii)QTA021P (expressing BDNF followed by eGFP separated by a functionalviral-2A peptide sequence), (iii) QTA022P (expressing BDNF followed byeGFP separated by a non-functional viral-2A peptide sequence) and (iv)QTA023P (expressing eGFP followed by coding for BDNF separated by afunctional viral-2A peptide sequence).

The coding sequence of QTA021P (plasmid containing codon optimisedsequence for mBDNF-viral-2A peptide-eGFP) is referred to here as SEQ IDNo: 104, as follows:

[SEQ ID No: 104] ATGACTATCCTGTTTCTGACAATGGTTATTAGCTATTTCGGTTGCATGAAGGCTCACAGTGATCCCGCACGCCGCGGAGAACTTAGCGTGTGCGACAGCATCAGCGAGTGGGTCACCGCCGCCGATAAGAAGACCGCTGTGGATATGTCCGGCGGGACCGTCACTGTACTCGAAAAAGTTCCAGTGAGCAAAGGCCAACTGAAACAATATTTCTATGAAACTAAGTGCAACCCCATGGGGTACACCAAGGAGGGCTGCCGGGGAATCGACAAGAGACACTGGAATTCCCAGTGCCGGACCACTCAGAGCTACGTCCGCGCCTTGACGATGGATTCAAAGAAGCGCATCGGATGGCGGTTCATAAGAATCGACACCAGTTGTGTGTGCACGCTGACGATAAAACGGGGGCGGGCCCCCGTGAAGCAGACCCTGAACTTTGATTTGCTCAAGTTGGCGGGGGATGTGGAAAGCAATCCCGGGCCAATGGTGAGCAAGGGCGAGGAGCTGTTCACCGGCGTTGTGCCAATACTGGTTGAGTTGGATGGCGATGTCAACGGACACAAATTTAGCGTAAGCGGGGAGGGAGAGGGCGACGCCACATATGGCAAGCTGACCCTGAAGTTCATTTGCACGACCGGCAAATTGCCCGTCCCTTGGCCCACACTTGTGACGACCCTGACTTATGGCGTACAGTGCTTCAGCAGGTACCCTGATCATATGAAGCAACACGACTTCTTTAAGAGTGCCATGCCAGAGGGATACGTCCAGGAAAGAACCATATTCTTCAAAGATGATGGAAATTACAAAACCCGGGCAGAGGTCAAGTTTGAAGGCGACACCCTGGTGAACAGGATCGAACTCAAAGGCATCGATTTCAAAGAGGACGGAAACATCCTCGGACACAAACTGGAATACAATTACAACAGCCACAACGTCTACATCATGGCAGATAAACAAAAGAACGGTATTAAAGTGAACTTCAAGATCCGGCACAACATCGAAGACGGCTCCGTCCAGCTTGCCGACCACTACCAGCAAAATACCCCGATCGGCGACGGCCCCGTTCTCCTCCCCGATAATCACTACCTGAGTACACAGTCAGCCTTGAGCAAAGACCCTAATGAAAAGCGGGACCACATGGTTTTGCTGGAGTTCGTTACCGCAGCGGGTATTACGCTGGGTATGGACGAGCTTTACAAG TAA

The coding sequence of QTA022P (plasmid containing codon optimisedsequence for mBDNF-non-functional viral-2A peptide-eGFP) is referred tohere as SEQ ID No: 105, as follows:

[SEQ ID No: 105] ATGACTATCCTGTTTCTGACAATGGTTATTAGCTATTTCGGTTGCATGAAGGCTCACAGTGATCCCGCACGCCGCGGAGAACTTAGCGTGTGCGACAGCATCAGCGAGTGGGTCACCGCCGCCGATAAGAAGACCGCTGTGGATATGTCCGGCGGGACCGTCACTGTACTCGAAAAAGTTCCAGTGAGCAAAGGCCAACTGAAACAATATTTCTATGAAACTAAGTGCAACCCCATGGGGTACACCAAGGAGGGCTGCCGGGGAATCGACAAGAGACACTGGAATTCCCAGTGCCGGACCACTCAGAGCTACGTCCGCGCCTTGACGATGGATTCAAAGAAGCGCATCGGATGGCGGTTCATAAGAATCGACACCAGTTGTGTGTGCACGCTGACGATAAAACGGGGGCGGGCCCCTGTCAAACAAACCCTCAATTTTGACTTGCTGAAGCTTGCTGGGGATGTCGAGTCCGCTGCCGCGGCTATGGTGAGCAAGGGCGAGGAGCTGTTCACCGGCGTTGTGCCAATACTGGTTGAGTTGGATGGCGATGTCAACGGACACAAATTTAGCGTAAGCGGGGAGGGAGAGGGCGACGCCACATATGGCAAGCTGACCCTGAAGTTCATTTGCACGACCGGCAAATTGCCCGTCCCTTGGCCCACACTTGTGACGACCCTGACTTATGGCGTACAGTGCTTCAGCAGGTACCCTGATCATATGAAGCAACACGACTTCTTTAAGAGTGCCATGCCAGAGGGATACGTCCAGGAAAGAACCATATTCTTCAAAGATGATGGAAATTACAAAACCCGGGCAGAGGTCAAGTTTGAAGGCGACACCCTGGTGAACAGGATCGAACTCAAAGGCATCGATTTCAAAGAGGACGGAAACATCCTCGGACACAAACTGGAATACAATTACAACAGCCACAACGTCTACATCATGGCAGATAAACAAAAGAACGGTATTAAAGTGAACTTCAAGATCCGGCACAACATCGAAGACGGCTCCGTCCAGCTTGCCGACCACTACCAGCAAAATACCCCGATCGGCGACGGCCCCGTTCTCCTCCCCGATAATCACTACCTGAGTACACAGTCAGCCTTGAGCAAAGACCCTAATGAAAAGCGGGACCACATGGTTTTGCTGGAGTTCGTTACCGCAGCGGGTATTACGCTGGGTATGGACGAGCTTTACAAG TAA

The coding sequence of QTA023P (plasmid containing codon optimisedsequence for eGFP-viral-2A peptide-mBDNF) is referred to here as SEQ IDNo: 106, as follows:

[SEQ ID No: 106] ATGGTGAGCAAGGGCGAGGAGCTGTTCACCGGGGTGGTGCCCATCCTGGTCGAGCTGGACGGCGACGTAAACGGCCACAAGTTCAGCGTGTCCGGCGAGGGCGAGGGCGATGCCACCTACGGCAAGCTGACCCTGAAGTTCATCTGCACCACCGGCAAGCTGCCCGTGCCCTGGCCCACCCTCGTGACCACCCTGACCTACGGCGTGCAGTGCTTCAGCCGCTACCCCGACCACATGAAGCAGCACGACTTCTTCAAGTCCGCCATGCCCGAAGGCTACGTCCAGGAGCGCACCATCTTCTTCAAGGACGACGGCAACTACAAGACCCGCGCCGAGGTGAAGTTCGAGGGCGACACCCTGGTGAACCGCATCGAGCTGAAGGGCATCGACTTCAAGGAGGACGGCAACATCCTGGGGCACAAGCTGGAGTACAACTACAACAGCCACAACGTCTATATCATGGCCGACAAGCAGAAGAACGGCATCAAGGTGAACTTCAAGATCCGCCACAACATCGAGGACGGCAGCGTGCAGCTCGCCGACCACTACCAGCAGAACACCCCCATCGGCGACGGCCCCGTGCTGCTGCCCGACAACCACTACCTGAGCACCCAGTCCGCCCTGAGCAAGGACCCCAACGAGAAGCGCGATCACATGGTCCTGCTGGAGTTCGTGACCGCCGCCGGGATCACTCTCGGCATGGACGAGCTGTACAAGGCTCCCGTTAAACAAACTCTGAACTTCGACCTGCTGAAGCTGGCTGGAGACGTGGAGTCCAACCCTGGACCTATGACCATCCTTTTCCTTACTATGGTTATTTCATACTTCGGTTGCATGAAGGCGCACTCCGACCCTGCCCGCCGTGGGGAGCTGAGCGTGTGTGACAGTATTAGCGAGTGGGTCACAGCGGCAGATAAAAAGACTGCAGTGGACATGTCTGGCGGGACGGTCACAGTCCTAGAGAAAGTCCCGGTATCCAAAGGCCAACTGAAGCAGTATTTCTACGAGACCAAGTGTAATCCCATGGGTTACACCAAGGAAGGCTGCAGGGGCATAGACAAAAGGCACTGGAACTCGCAATGCCGAACTACCCAATCGTATGTTCGGGCCCTTACTATGGATAGCAAAAAGAGAATTGGCTGGCGATTCATAAGGATAGACACTTCCTGTGTATGTACACTGACCATTAAAAGGGGAAGA TAG

Referring to FIG. 14A, there is shown a Western blot of HEK293 cellhomogenates 48 hours after transfection with the QTA020V vector. Itshows efficient processing of the large precursor coding region whichincludes the TrkB receptor and BDNF separated by the viral-2A peptidesequence. The two TrkB and mBDNF-immunoreactive transgenes are within inthe predicted correct molecular weight sizes. A lack of staining oflarge precursor protein above the TrkB receptor band should be noted,indicating almost complete or complete processing of the precursorprotein in five repeats. FIGS. 14B and 14C show that the transgeneproteins produced after vial-2A peptide cleavage have been transportedto the correct intracellular compartments in HEK293 cells afterprocessing (TrkB receptors to the cell surface and BDNF to storagevesicles prior to release).

FIG. 15 shows that addition of the viral-2A peptide sequence separatingthe two coding regions for the TrkB receptor and BDNF results inefficient processing into the two transgenes in mouse retina followingintravitreal injection of the rAAV2 vector, QTA020V.

FIG. 16 shows the expression of transgenes in mouse retinal ganglioncell layer as shown by immunocytochemistry following injection ofQTA020V, a rAAV2 vector containing the coding for the TrkB receptor andBDNF, separated by the viral-2A peptide sequence. Target retinalganglion cell bodies are stained red with anti-Brn3A antibodies and cellnuclei are counter-stained blue with DAPI to distinguish the retinallayers.

Referring to FIG. 17, there is shown pre-treatment of QTA020V(containing coding for TrkB receptor and BDNF, separated by the viral-2Apeptide sequence) via intravitreal injection (2 μl of 9×10¹² vectorparticles/ml) imparts significant neuroprotective efficacy on retinalganglion cell survival following optic nerve crush in the mouse versuscontrol animals treated with rAAV2-CAG-eGFP vector. The level ofneuroprotection by the QTA020V vector was also greater than thatprovided by a vector expressing only BDNF. All three groups of animalswere subjected to optic nerve crush procedure and the number of retinalganglion cells measured 7 days after the insult. Retinal ganglion cellswere reduced by 71% in controls (black bars) versus animals subject tosham crush (data not shown).

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1. A genetic construct comprising a promoter operably linked to a firstcoding sequence, which encodes the tyrosine kinase receptor B (TrkB),and a second coding sequence, which encodes an agonist of the TrkBreceptor.
 2. (canceled)
 3. (canceled)
 4. A genetic construct accordingto claim 1, wherein the promoter is the human synapsin I (SYN I)promoter or the CAG promoter.
 5. (canceled)
 6. A genetic constructaccording to claim 1, wherein the genetic construct comprises a spacersequence disposed between the first and second coding sequences, whichspacer sequence encodes a peptide spacer that is configured to bedigested to thereby produce the TrkB receptor and agonist as separatemolecules.
 7. A genetic construct according to claim 6, wherein thespacer sequence comprises and encodes a viral peptide spacer sequence,more preferably a viral 2A peptide spacer sequence.
 8. A geneticconstruct according to claim 6, wherein the peptide spacer sequencecomprises an amino acid sequence substantially as set out in SEQ ID NO.4, or a fragment or variant thereof; or (ii) an amino acid sequencesubstantially as set out in SEQ ID NO. 6, or a fragment or variantthereof; or (iii) an amino acid sequence substantially as set out in SEQID NO. 8, or a fragment or variant thereof.
 9. A genetic constructaccording to claim 6, wherein the spacer sequence comprises: (i) anucleotide sequence substantially as set out in SEQ ID NO.5, or afragment or variant thereof; or (ii) a nucleotide sequence substantiallyas set out in SEQ ID NO. 7, or a fragment or variant thereof. 10.(canceled)
 11. (canceled)
 12. (canceled)
 13. A genetic constructaccording to claim 1, wherein the first coding sequence comprises anucleotide sequence encoding the human canonical isoform of TrkBcomprising an amino acid sequence substantially as set out in SEQ ID NO.9, or a fragment or variant thereof, and/or wherein the first codingsequence comprises a nucleotide sequence substantially as set out in SEQID NO. 10, or a fragment or variant thereof.
 14. (canceled)
 15. Agenetic construct according to claim 1, wherein the first codingsequence comprises a nucleotide sequence which encodes isoform 4 ofTrkB, and (i) wherein isoform 4 of TrkB comprises an amino acid sequencesubstantially as set out in SEQ ID NO. 11, or a fragment or variantthereof, and/or (ii) wherein the first coding sequence comprises anucleotide sequence substantially as set out in SEQ ID NO. 12, or afragment or variant thereof.
 16. (canceled)
 17. (canceled)
 18. A geneticconstruct according to claim 1, wherein the first coding sequencecomprises a nucleotide sequence encoding a mutant form of TrkB receptor,wherein one or more tyrosine residue at position 516, 701, 705, 706and/or 816 of SEQ ID No: 9 is modified or mutated and/or wherein atleast two, three or four tyrosine residues at position 516, 701, 705,706 and/or 816 of SEQ ID No: 9 are modified, and/or wherein all fivetyrosine residues at position 516, 701, 705, 706 and/or 816 of SEQ IDNo: 9 are modified, and/or wherein the or each tyrosine residue ismodified to a glutamic acid.
 19. (canceled)
 20. (canceled) 21.(canceled)
 22. A genetic construct according to claim 18, wherein themodified form of the TrkB receptor comprises an amino acid sequencesubstantially as set out in SEQ ID NO. 13, or a fragment or variantthereof, and/or wherein the first coding sequence comprises a nucleotidesequence substantially as set out in SEQ ID NO. 14, or a fragment orvariant thereof.
 23. (canceled)
 24. A genetic construct according toclaim 1, wherein the second coding sequence encodes an agonist of theTrkB receptor, which is a member of the neurotrophin family of trophicfactors, and wherein the agonist is selected from a group of agonistsconsisting of: Brain-derived neurotrophic factor (BDNF); nerve growthfactor (NGF); neurotrophin-3 (NT-3); neurotrophin-4 (NT-4); andneurotrophin-5 (NT-5); or fragments thereof.
 25. A genetic constructaccording to claim 24, wherein the second coding sequence encodesneurotrophin-4 (NT-4), which comprises an amino acid sequencesubstantially as set out in SEQ ID NO: 49 or 55, or a fragment orvariant thereof, and/or the second coding sequence comprises anucleotide sequence substantially as set out in SEQ ID No: 50 or 56, ora fragment or variant thereof.
 26. A genetic construct according toclaim 1, wherein the agonist of the TrkB receptor is prepro-brainderived neurotrophic factor (pre-pro-BDNF), pro-BDNF or mature BDNF(mBDNF), wherein the proBDNF is canonical proBDNF, optionally whereincanonical proBDNF comprises an amino acid sequence substantially as setout in SEQ ID NO. 15, or a fragment or variant thereof, or wherein thesecond coding sequence comprises a nucleotide sequence substantially asset out in SEQ ID NO. 16, or a fragment or variant thereof, and/orwherein the proBDNF is isoform 2 of proBDNF, optionally wherein isoform2 of proBDNF comprises an amino acid sequence referred to herein as SEQID NO. 17, or a fragment or variant thereof.
 27. (canceled) 28.(canceled)
 29. A genetic construct according to claim 26, wherein thesecond coding sequence comprises a nucleotide sequence which encodesmature BDNF, and/or wherein mature BDNF comprises an amino acid sequencesubstantially as set out in SEQ ID NO. 18, or a fragment or variantthereof, and/or wherein the second coding sequence comprises anucleotide sequence substantially as set out in SEQ ID NO. 19, or afragment or variant thereof.
 30. (canceled)
 31. (canceled)
 32. A geneticconstruct according to claim 1, wherein the second coding sequencecomprises a nucleotide sequence encoding a signal peptide for theagonist of the TrkB receptor, preferably a signal peptide for BDNF,optionally wherein the nucleotide sequence encodes the canonical signalpeptide for BDNF.
 33. (canceled)
 34. A genetic construct according toclaim 32, wherein the second coding sequence comprises a nucleotidesequence which encodes a signal peptide comprising an amino acidsequence substantially as set out in SEQ ID NO. 20, or a fragment orvariant thereof, and/or wherein the second coding sequence comprises anucleotide sequence substantially as set out in SEQ ID NO. 21, or afragment or variant thereof.
 35. (canceled)
 36. A genetic constructaccording to claim 1, wherein the second coding sequence comprises anucleotide sequence encoding a signal sequence peptide substantially asset out in any one of SEQ ID NO. 23, 25, 27 or 29, or wherein the signalpeptide comprises an amino acid sequence substantially as set out in anyone of SEQ ID NO. 22, 24, 26 or 28, and/or wherein the second codingsequence comprises a nucleotide sequence encoding a signal sequencepeptide substantially as set out in any one of SEQ ID NO. 31, 33, 35,37, 39, 41, 43, 45, 61, 63, 65, 67, 69, 71, 73, 75, 77, 79, 81, 83, 85,87, 89, 91, 93, 95, 97, 99, 101 or 103; or wherein the signal peptidecomprises an amino acid sequence substantially as set out in any one ofSEQ ID NO. 30, 32, 34, 36, 38, 40, 42, 44, 60, 62, 64, 66, 68, 70, 72,74, 76, 78, 80, 82, 84, 86, 88, 90, 92, 94, 96, 98, 100 or
 102. 37.(canceled)
 38. A genetic construct according to claim 1, wherein theconstruct comprises a nucleotide sequence substantially as set out inSEQ ID No: 107 or 108, or a fragment or variant thereof.
 39. Arecombinant vector comprising the genetic construct according to claim1, wherein the vector is a recombinant AAV (rAAV) vector, optionallywherein the rAAV is AAV-1, AAV-2, AAV-3A, AAV-3B, AAV-4, AAV-5, AAV-6,AAV-7, AAV-8, AAV-9, AAV-10 or AAV-11.
 40. (canceled)
 41. (canceled) 42.(canceled)
 43. (canceled)
 44. (canceled)
 45. (canceled)
 46. (canceled)47. (canceled)
 48. A pharmaceutical composition comprising the geneticconstruct according to claim 1, and a pharmaceutically acceptablevehicle.
 49. (canceled)
 50. A method of treating, preventing orameliorating an optic nerve disorder or a cochlear disorder in asubject, or for promoting nerve regeneration and/or survival in asubject, the method comprising administering, to a subject in need ofsuch treatment, a therapeutically effective amount of the geneticconstruct according to claim
 1. 51. The method according to claim 50,wherein the optic nerve disorder that is treated is anypathophysiological condition which results in loss of RGCs, such astrauma to the head or face or vascular insults, for example partial orcomplete loss in blood supply to the ocular structures or regions of thebrain which receive input from the optic nerve, or is used to supportreplacement of RGCs through introduction of untransformed or transformedstem cell into the eye or regions associated with vision in patients,optionally wherein the optic nerve disorder that is treated is glaucoma,or wherein the cochlear disorder which is treated is hearing loss ordeafness.